Continued Service Use Research Articles

Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives

BackgroundQuality of care is a multidimensional concept that forms an integral part of the uptake and use of modern contraceptive methods. Satisfaction with services is a significant factor in the continued use of services. While much is known about quality of care in the general public health care service, little is known about family planning specific quality of care in South Africa. This paper aims to fill the gap in the research by using the Bruce-Jain family planning quality of care framework.MethodsThis formative qualitative study was conducted in South Africa, Zambia, and Kenya to explore the uptake of family planning and contraception. The results presented in this paper are from the South African data. Fourteen focus group discussions, twelve with community members and two with health care providers, were conducted along with eight in-depth interviews with key informants. Thematic content analysis using the Bruce-Jain Quality of Care framework was conducted to analyse this data using NVIVO 10.ResultsFamily planning quality of care was defined by participants as the quality of contraceptive methods, attitudes of health care providers, and outcomes of contraceptive use. The data showed that women have limited autonomy in their choice to either use contraception or the method that they might prefer. Important elements that relate to quality of care were identified and described by participants and grouped according to the structural or process components of the framework. Structure-related sub-themes identified included the lack of technically trained providers; integration of services that contributed to long waiting times and mixing of a variety of clients; and poor infrastructure. Sub-themes raised under the process category included poor interpersonal relations; lack of counselling/information exchange, fear; and time constraints. Neither providers nor users discussed follow up mechanisms which is a key aspect to ensure continuity of contraceptive use.ConclusionUsing a qualitative methodology and applying the Bruce-Jain Quality of Care framework provided key insights into perceptions and challenges about family planning quality of care. Identifying which components are specific to family planning is important for improving contraceptive outcomes. In particular, autonomy in user choice of contraceptive method, integration of services, and the acceptability of overall family planning care was raised as areas of concern.

Mental Health Service Utilization: General and Gendered Consequences for Prison Strains

Nearly half of the incarcerated population experience mental health problems. Service use, however, is rare. There may be benefits for individuals who continue treatment upon incarceration (i.e., fewer or less intense pains of imprisonment). Researchers suggest that effects of treatment may differ by gender; distinct barriers to services may exist and accessing treatment may have unique effects on experienced strains. No study to date examines whether continuation of services protects at-risk groups from in-prison strains, and whether these effects are gendered. This article examines the effects of service utilization using a nationally representative sample of inmates. Results indicate that effects of continued service use vary, protecting women against some in-prison strains. Implications for theory, research, and policy are discussed.

Who needs social networking? An empirical enquiry into the capability of Facebook to meet human needs and satisfaction with life

Social Network Sites (SNS) have been the topic of much scholarly and public debate for the most part of the 21st century. A number of studies have investigated the benefits and drawbacks to using SNS, with Facebook the largest example boasting billions of active monthly users. In recent months, media commentary has raised a number of concerning cases surrounding Facebook's use of data, its connection with other organizations and its legitimacy, making a number of open public calls to abandon the platform. However, active users still number in the billions, raising the question, “does Facebook achieve something on a fundamental human and social level that users are willing to overlook the potential drawback to its use?” Using Maslow's needs hierarchy, this study adopts a survey approach (n = 316) and explores the capacity for Facebook to satisfy human needs. Findings identify Facebook as a useful tool to fulfil human needs, which predict continued Facebook use intentions of participants, and further, satisfaction with life. These findings offer a broad-based view of use and its resonance with key motivators of behavior, supporting both Maslow's needs hierarchy and highlighting the importance of need fulfilment for continued service use and satisfaction with life.

Parents' Perceptions of Benefit of Children's Mental Health Treatment and Continued Use of Services

The authors examined the association of demographic and clinical characteristics, family history, and type of treatment among children receiving outpatient mental health services and parents' perception of treatment benefit. They also examined whether perceived benefit was related to continued use of services at six-month follow-up. Parents of children age six to 12 years who were first-time patients at one of nine clinics participating in the Longitudinal Assessment of Manic Symptoms (LAMS) study completed the Parent General Behavior Inventory Ten-Item Mania Scale. Parents of children with scores of 12 or higher (N=1,124) were invited to participate in a follow-up study, and 621 agreed. During baseline assessment after the first outpatient visit and at six-month follow-up, the parents were asked about children's sociodemographic and diagnostic characteristics and use of services and asked to rate how much their children had benefited from the most recent outpatient treatment. Data were available for 573 children. At baseline, parents of 167 (29%) children reported that the treatment provided a lot of benefit, and perceived benefit was related to receiving medication (with or without therapy) versus just therapy, higher scores on functioning, LAMS site, no history of comorbid diagnoses, living with both biological parents, and having no parents or siblings with a prior hospitalization for a psychiatric illness. At six-month follow-up, perceived benefit was related to continued use of services (p<.001). Medication with or without therapy was perceived as more beneficial than therapy alone. Perceived benefit was strongly related to continued use of treatment.

Correlates of Mental Health Service Use Intensity in the National Comorbidity Survey and National Comorbidity Survey Replication

This study explored sociodemographic and mental health correlates of intensity of mental health care use in two large-scale surveys, aiming to discover the set of correlates with the greatest predictive capacity. Data were examined from persons aged 15 to 54 in two nationally representative U.S. household surveys: the National Comorbidity Survey (NCS) (N=5,877), which gathered information from 1990 to 1992, and the NCS Replication (N=4,320), which gathered information from 2001 to 2003. Outcome variables were the number of mental health care visits in the past year to mental health providers, social service providers, and medical providers. This study implemented state-of-the-art statistical methods designed for modeling such outcomes as treatment intensity-that is, visit counts. Across provider types, significant univariate associations were found for intensity of mental health care use based on access variables (for example, employment and health insurance) and two need variables-psychiatric diagnoses and psychiatric disability. Demographic variables and treatment need variables were not consistent service use correlates. Multivariate regression accounting for excessive zero values demonstrated that after the analyses controlled for sociodemographic and access variables, mental disorders (mood, anxiety, and substance use disorders) and psychiatric disability added incrementally to variance in visit counts for mental health care. However, when mental health service use was dichotomized (any use versus no use) demographic and access variables, as well as psychiatric disorders, emerged as correlates. In both sets of analyses, different patterns of psychiatric disorder and disability were associated with provider service use. These findings extend research on correlates of mental health care use, addressing intensity of use, suggesting that sociodemographic factors and presence of a psychiatric disorder and associated disability drive the initial use of services, whereas presence of a psychiatric disorder and associated disability are associated with continued service use.

General medical and pharmacy claims expenditures in users of behavioral health services

To quantify the magnitude of general medical and/or pharmacy claims expenditures for individuals who use behavioral health services and to assess future claims when behavioral service use persists. Retrospective cost trends and 24-month cohort analyses. A Midwest health plan. Over 250,000 health plan enrollees during 2000 and 2001. Claims expenditures for behavioral health services, general medical services, and prescription medications. Just over one tenth of enrollees (10.7%) in 2001 had at least 1 behavioral health claim and accounted for 21.4% of total general medical, behavioral health, and pharmacy claims expenditures. Costs for enrollees who used behavioral health services were double that for enrollees who did not use such services. Almost 80% of health care costs were for general medical services and medications, two thirds of which were not psychotropics. Total claims expenditures in enrollees with claims for both substance use and mental disorders in 2000 were 4 times that of those with general medical and/or pharmacy claims only. These expenditures returned to within 15% of nonbehavioral health service user levels in 2001 when clinical need for behavioral health services was no longer required but increased by another 37% between 2000 and 2001 when both chemical dependence and mental health service needs persisted. The majority of total claims expenditures in patients who utilize behavioral health services are for medical, not behavioral, health benefits. Continued service use is associated with persistently elevated total general medical and pharmacy care costs. These findings call for studies that better delineate: 1) the interaction of general medical, pharmacy, and behavioral health service use and 2) clinical and/or administrative approaches that reverse the high use of general medical resources in behavioral health patients.