Cross-sectional Secondary Data Research Articles

Documentation of social determinants of health across individuals from different racial and ethnic groups in home healthcare.

Home healthcare (HHC) enables patients to receive healthcare services within their homes to manage chronic conditions and recover from illnesses. Recent research has identified disparities in HHC based on race or ethnicity. Social determinants of health (SDOH) describe the external factors influencing a patient's health, such as access to care and social support. Individuals from racially or ethnically minoritized communities are known to be disproportionately affected by SDOH. Existing evidence suggests that SDOH are documented in clinical notes. However, no prior study has investigated the documentation of SDOH across individuals from different racial or ethnic backgrounds in the HHC setting. This study aimed to (1) describe frequencies of SDOH documented in clinical notes by race or ethnicity and (2) determine associations between race or ethnicity and SDOH documentation. Retrospective data analysis. We conducted a cross-sectional secondary data analysis of 86,866 HHC episodes representing 65,693 unique patients from one large HHC agency in New York collected between January 1, 2015, and December 31, 2017. We reported the frequency of six SDOH (physical environment, social environment, housing and economic circumstances, food insecurity, access to care, and education and literacy) documented in clinical notes across individuals reported as Asian/Pacific Islander, Black, Hispanic, multi-racial, Native American, or White. We analyzed differences in SDOH documentation by race or ethnicity using logistic regression models. Compared to patients reported as White, patients across other racial or ethnic groups had higher frequencies of SDOH documented in their clinical notes. Our results suggest that race or ethnicity is associated with SDOH documentation in HHC. As the study of SDOH in HHC continues to evolve, our results provide a foundation to evaluate social information in the HHC setting and understand how it influences the quality of care provided. The results of this exploratory study can help clinicians understand the differences in SDOH across individuals from different racial and ethnic groups and serve as a foundation for future research aimed at fostering more inclusive HHC documentation practices.

How military-related stress and family relationships are associated with perceptions of work-family impact for married male service members with adolescent children

ABSTRACT Family members’ perceptions of challenges associated with military life can spillover to their relationships with one another and, in turn, inform service members’ beliefs of how their work impacts family life. The current study examined connections between active-duty fathers’, civilian mothers’, and adolescents’ perceptions of military-related stress, adolescents’ perceptions of quality of family relationships (i.e. parent-adolescent relationships), and service members’ perceived work-family impact (specifically work-related guilt and work-related enrichment). To examine these associations, a path analysis with secondary cross-sectional data was estimated using data from 228 Army families (each with an active-duty father, civilian mother, and adolescent offspring). The findings suggested that service members’ perceptions of military-related stress and adolescents’ relationship quality with both parents were related to service members’ work-family impact, specifically work-related enrichment. Such associations highlight the importance of high-quality parent-adolescent relationships for active-duty fathers’ work-family impact, which has implications for military families but, more broadly, for service members’ readiness and retention.

Choosing a maternity hospital: a matter of travel distance or quality of care?

BackgroundThe choice of a hospital should be based on individual need and accessibility. For maternity hospitals, this includes known or expected risk factors, the geographic accessibility and level of care provided by the hospital. This study aims to identify factors influencing hospital choice with the aim to analyze if and how many deliveries are conducted in a risk-appropriate and accessible setting in Bavaria, Germany.MethodsThis is a cross-sectional secondary data analysis based on all first births in Bavaria (2015-18) provided by the Bavarian Quality Assurance Institute for Medical Care. Information on the mother and on the hospital were included. The Bavarian Index of Multiple Deprivation 2010 was used to account for area-level socioeconomic differences. Multiple logistic regression models were used to estimate the strength of association of the predicting factors and to adjust for confounding.ResultsWe included 195,087 births. Distances to perinatal centers were longer than to other hospitals (16 km vs. 12 km). 10% of women with documented risk pregnancies did not deliver in a perinatal center. Regressions showed that higher age (OR 1.03; 1.02–1.03 95%-CI) and risk pregnancy (OR 1.44; 1.41–1.47 95%-CI) were associated with choosing a perinatal center. The distances travelled show high regional variation with a strong urban-rural divide.ConclusionIn a health system with free choice of hospitals, many women chose a hospital close to home and/or according to their risks. However, this is not the case for 10% of mothers, a group that would benefit from more coordinated care.

The Odds of Meeting Physical Activity Guidelines in Children Receiving School-Based Fitness Testing Awards: NHANES 2013–2016

Fitness testing and awards have been used in physical education classrooms for over 50 years. While their initial intention was to promote physical activity engagement, analyses show they are not achieving their goal. This article highlights fitness testing awards and the need to re-evaluate how they can help meet the physical activity guidelines for children ages 5 to 15 years. A cross-sectional secondary data analysis was employed using data from the 2013-2016 National Health and Nutrition Examination Survey (N = 3973). Analysis results showed that receiving fitness awards is not associated with children meeting physical activity guidelines. It is thus important for physical education teachers and school administrators to adopt and implement process-based fitness testing awards (e.g., giving awards for an individual's fitness-behavior goal achievement or improvement) along with performance-based fitness awards to enhance children's physical activity levels.

Co-occurring psychological distress and alcohol or other drug use among Indigenous Australians: Data from the National Aboriginal and Torres Strait Islander Health Survey.

To determine the prevalence and demographic, social and health characteristics associated with co-occurring psychological distress symptoms, risky alcohol and/or substance use among a national sample of Aboriginal and Torres Strait Islander people aged 15 years or older. This study uses secondary cross-sectional data from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). Data were collected via face-to-face interviews with those living in private dwellings across Australia. Participants were Aboriginal and Torres Strait Islander people (n = 10,579) aged 15 years or older. Data pertaining to psychological distress, alcohol and substance use were obtained and weighted to represent the total population of Aboriginal and Torres Strait Islander people in Australia. A total of 20.3% participants were found to have co-occurring psychological distress, risky alcohol use and/or substance use, and 4.0% reported co-occurrence of all three conditions. Female participants in a registered marriage and fully engaged in study or employment had lower rates of co-occurring conditions. Poorer self-rated health, one or more chronic conditions and increased experiences of unfair treatment and physical harm in the past 12 months were associated with increased rates of co-occurring conditions. A range of potential risk and protective factors were identified for co-occurring psychological distress, risky alcohol and/or substance use among Aboriginal and Torres Strait Islander people. This information is critical for planning effective holistic strategies to decrease the burden of suffering imposed upon the individual, family and community members impacted by co-occurring conditions.

Children with disabilities lack access to nutrition, healthand WASH services: A secondary data analysis.

Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitationand hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy amonghouseholds with and without children with disabilities in Uganda. We used cross-sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASHand dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55-0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02-1.22, p = 0.012). The proportion of malnourished children was higher amonghouseholds with children with disabilities than households without it (6.3% vs. 2.4% p < 0.001). There are concerning gaps in access to NaHS services in Uganda, with households with children with disabilities reporting worse access, particularly for those with low WASH adequacy. Improved and inclusive access to NaHS and WASH needs to be urgently prioritized, especially for children with disabilities.

Sociodemographic factors underlying lifetime fertility among ever-married Swazi women.

Fertility rates remain high in certain subgroups of the population, and there is limited research about the sociodemographic factors influencing fertility, particularly in Eswatini where women are often considered minors. This study aims to investigate the changes in lifetime fertility, and the associations between sociodemographic factors and lifetime fertility among ever-married women. The study used secondary cross-sectional data from the 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys (MICS), with a sample size of 2,295 and 2,351 women, respectively. The data was analysed using descriptive statistics and multivariable Poisson regression. The results showed that fertility rates decreased from 3.47 to 3.21 children between 2010 and 2014. The study found that child loss and age (25+ years) were significant factors associated with higher fertility, while delayed age at marriage and sexual debut (20+ years), at least secondary education, and being rich were strong predictors of lower fertility rates. The study recommends creating awareness about and strengthening laws to abolish early sexual debut and marriage. It also suggests empowering women through education, encouraging the use of contraceptives, and providing maternal and child health services in rural areas where fertility rates tend to be higher.

Emergency Preparedness Among Community-Dwelling Older Adults: Risk and Protective Factors

ABSTRACT Recent increases in natural (e.g. extreme weather) and human-caused (e.g. industrial accidents) have raised concerns for public health and safety. Older adults face greater vulnerability and are often less prepared for these emergencies. Applying the risk and protective factor model, this study explored factors associated with emergency preparedness among older people living in the community. We analyzed cross-sectional secondary data obtained from the National Poll on Healthy Aging to compare factors associated with emergency preparedness among community-dwelling older people aged 60–69 (n = 383) and 70–80 (n = 370). Results showed that among all community-dwelling older adults, having previously discussed evacuation plans with family or friends was associated with a higher level of emergency preparedness. Among those aged 60–69, experience with an emergency in the past year was associated with a higher level of emergency preparedness, whereas living alone and having a Hispanic background were associated with a lower level of emergency preparedness. For those aged 70–80, higher perceived mental health was associated with a higher level of emergency preparedness. Implications focus on shifting the perspective of the disproportional risks for older adults around emergencies to one that values and supports older adults’ strengths and insights.

An empirical analysis of the demand for family planning satisfied by modern methods among married or in-union women in Nigeria: Application of multilevel binomial logistic modelling technique.

Given the health and economic benefits of family planning (FP), Nigeria's very low demand for FP satisfied by modern methods (mDFPS) of less than 50% is therefore a major public health concern, especially considering the global target aimed at achieving an mDFPS of at least 75% by year 2030 for all countries. In view of this, together with recognising the possible contextual nature of health outcomes, this study aimed to empirically analyse the mDFPS among married or in-union women of reproductive age (WRA) in Nigeria. A multilevel binomial logistic model with two levels of analysis was used: individual and community levels. Secondary cross-sectional data were obtained from the 2018 Nigeria Demographic and Health Survey, and analyses were performed using Stata 15.0. The analytical sample size was 9,122 WRA nested in a total of 1,072 communities. The mDFPS was approximately 31.0%. The median odds ratio (MOR) estimated from the final multilevel model was 2.245, which was greater than the adjusted odds ratio (aOR) for most of the individual-level variables, suggesting that the unexplained/residual between-community variation in terms of the odds of women having their mDFPS was more relevant than the regression effect of most of the individual-level variables. This was with the exception of the regression effects of the following individual-level variables: women's husbands that had higher education level in comparison to their counterparts who had husbands with no formal education (aOR = 2.539; 95% CI = 1.896 to 3.399; p<0.001); and women from the Yoruba ethnic group in comparison to their counterparts from the Hausa/Fulani/Kanuri ethnic group (aOR = 2.484; 95% CI = 1.654 to 3.731; p value<0.001). However, other individual-level variables with positive statistically significant regression effects on mDFPS were: women who mentioned that money for accessing health care was not a problem; women's empowerment in relation to the visitation of family and relatives; and women being exposed to FP messages through various media sources, all in comparison to their respective counterparts. On the other hand, at the community level, women in communities where a high percentage of them had at least a secondary education had statistically significant greater odds of having mDFPS than women in communities with lower education levels (aOR = 1.584; 95% CI = 1.259 to 1.991; p<0.001). We found similar findings regarding women residing in communities with exposure to FP messages through various media sources. However, using the 80% interval ORs (80% IORs) as a supplemental statistical measure for further understanding the regression effects of community-level variables showed that all of the 80% IORs had a value of '1', signifying considerable uncertainty in the regression effects of all community-level variables due to the substantial residual variation existing between communities. Our study showed that to achieve the dire increase in mDFPS in Nigeria, policy interventions aimed at improving the education level of both females and males, especially beyond the secondary school level, should be implemented. Additionally, all of the various media sources should be extensively utilised, both at the individual and the community level, by the Nigerian government to spread information on the importance of women having their mDFPS.

Prevalence and correlates of paediatric guideline non-adherence for initial empirical care in six low and middle-income settings: a hospital-based cross-sectional study

ObjectivesThis study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings.Design and settingWe used secondary cross-sectional data from eight healthcare facilities in six Asian...

The Role of Economic and Social Factors Affecting the Efficiency of Small-Scale Sunflower Oil Production Companies in Tanzania

Most developing nations, including Tanzania, consider agro-processing a key to industrialization. Despite an attractive sunflower seed yield, Tanzania's sunflower oil processing and production have been staggering over the years. Sunflower oil production is inefficient, which leads to low output. So, this research studied sunflower oil production technical efficiency in the Singida region. The study examined the social and economic factors that affect technical efficiency in small-scale sunflower oil producers. It applied cross-sectional design and secondary data for the years 2016–2017, which were collected from the Central Zone Sunflower Oil Processors Association and Small Industrial Development Organization based on Singida sunflower oil producers. It also used stochastic frontier analysis and multiple linear regressions to find the empirical economic relationship between the variables. Sunflower oil producers averaged 30.1% less technical efficiency, as the average was 69.9%. It also revealed that labor, seed, capital, and electricity affect production, while age, experience, education, and locality also matter. Finally, processing techniques, socio-economic, and demographic differences affect sunflower oil production. So, producers must increase capital inputs to be technically efficient. Consider boosting producer capacity and abilities and observing a minimum number of productive staff.

Child Anxiety and Depression During the COVID-19 Pandemic and Unmet Mental Health Care Needs.

Child anxiety and depression increased in recent years, while access to health care improved in some ways and worsened in others. The purpose of this study was to understand the prevalence of child anxiety and depression during the COVID-19 pandemic, unmet mental health care need among children with these conditions, and whether disparities exist by race/ethnicity and sex. A cross-sectional secondary data analysis was conducted using the 2021 National Survey of Children's Health (ages 3-17 years, unweighted n = 42,175). Parent/caregiver-reported child anxiety and depression prevalence was greater among non-Hispanic White children than those of other racial/ethnic groups and females compared to males, after adjusting for covariates. Unmet mental health care need among children with anxiety and depression was greater among Hispanic children than those of other racial/ethnic groups, after adjusting for covariates. In conclusion, this study identified a disparity in unmet need between Hispanic children and those of other races and ethnicities. Implications for policy and practice are discussed.

Interprofessional Educational Needs for Shared Governance of Integrated Care.

This study investigated the educational needs of integrated care among professionals in the public sector of healthcare and social care services in South Korea. A cross-sectional secondary data analysis was performed. Original data were obtained from 10 metropolitan communities with a convenience sample of 210 integrated care professionals. The Borich Needs Assessment Model and the Locus for Focus Model were used to examine the priority educational needs of each integrated care professional. This study analyzed the key details of educational needs in integrated care by focusing on the competencies of integrated care approaches for person-centered care, interprofessional collaboration, and community involvement. The core educational needs of community care administrators, care coordinators, healthcare and social care providers, and community health champions, which are common to all professionals, and the specific educational needs for each type of professional were demonstrated, which contained specific content to implement integrated care. This study provides an opportunity to comprehensively understand the educational needs of integrated care professionals based on their competencies. They want better interprofessional cooperation through networking and collaborative strategies. The results of this study may be utilized as fundamental data by future instructors to provide evidence-based education programs.

Factors associated with an unsuppressed viral load among HIV-positive individuals attending STI services in South Africa, 2019

BackgroundSexually transmitted infections (STIs), particularly in the absence of viral suppression, increase the risk of HIV transmission to uninfected partners. We determined factors associated with having an unsuppressed VL among HIV-positive individuals attending STI services in South Africa (SA).MethodsWe analysed secondary cross-sectional data collected on HIV-positive individuals presenting with STI symptoms s at sentinel sites in Western Cape and Gauteng provinces between January–December 2019 in SA. We compared demographic characteristics of individuals on ART or not on ART, and a Poisson regression model to identify factors associated with having an unsuppressed VL (≥ 50 copies/ml) was used.ResultsAmong 93 HIV-positive individuals attending STI services with VL data, the median age was 32 years (IQR 27–37). Thirty-two (34.41%) individuals were on ART compared to 61 (65.59%) not on ART. Most of those on ART (56.25%) had an unsuppressed VL, while 86.89% of those not on ART had an unsuppressed VL. ART use was associated with a 33% lower prevalence of having unsuppressed VL. In a model adjusting for age, age at first sex and oral sex, none of the factors were significant. Among those on ART, individuals < 25 years were more likely to have an unsuppressed VL (aPRR = 1.94: 95% CI = 1.27–2.97) compared to those ≥ 25 years.ConclusionART use among HIV-positive individuals was low and VL suppression among those on ART was sub-optimal. Intensified ART initiation and adherence support to HIV-positive individuals seeking STI services could improve VL suppression.

Association of socioeconomic conditions and quality of life with depression among Laos migrant workers in Northeast Thailand: multilevel-level logistics regression analysis

Currently, an increasing number of workers are migrating to Thailand; a trend that is increasing along with the economic growth of the country. However, the cultural conditions, traditions and adjustments of migrant workers in Thailand have a significant impact on their mental state, leading to mental health problems. This study used a cross-sectional analytical study design and secondary data. This study investigated the relationship of socioeconomic conditions and quality of life with depression among migrant workers from Laos employed in Northeast Thailand. The study was conducted from January 2019 to December 2020. Study participants included 1,205 Laos migrant workers working in Northeast Thailand. Data was analysed using Multi-level Logistic Regression Analysis to determine the relationship of socioeconomic conditions and quality of life with depression. The effects of covariates were controlled and adjusted odds ratio (AOR) values and 95% confidence intervals (CI) are presented. The results of the study revealed that the prevalence of depression was 9.29% (95%CI: 7.78–11.07) and factors affecting depression among Laos migrant workers included low-moderate psychological quality of life (AOR =6.69, CI: 2.96–15.10), low-moderate social quality of life (AOR =4.00, 95%CI: 2.32–6.99) and sufficient income but no savings (AOR=2.56, 95%CI: 1.57–4.19). Therefore, agencies related to migrant workers should focus on developing policies that promote their quality of life, as it directly affects their mental health. This should include the development of social and psychological quality of life as well as income and well-being security, which serves as the foundation for workers who contribute to the country’s sustainable economic and industrial development.

Exploring the relationship between sleep and aggression in adolescents: A cross sectional study using the UK Millennium cohort study.

This study aimed to establish if a significant relationship exists between sleep and aggression in a large representative adolescent cohort and explores the impact of potential confounders. This cross-sectional secondary data analysis included 10,866 males and females aged 13-15years, from the UK-based 2015 Millenium Cohort Study (sixth sweep). Independent variables included self-report measures of sleep duration and quality. The parent reported 'Strengths and Difficulties Questionnaire' conduct score measured aggression. Binary logistic regression examined independent associations between each sleep variable and aggression. Multiple regression models then adjusted for potential confounders: age, sex, socioeconomic status, arousal, and affect. Under 8hours of sleep on average was significantly associated with aggression when age, sex and income were controlled (p = .008). This became insignificant following adjustment for both affect and arousal. Sleep quality remained significantly associated with aggression when all confounders were controlled: 'sleep onset latency >30minutes' and 'wakening at least a good bit of the time' increased the odds of aggression by around 27.9% (p < .001) and 43.5% respectively (p < .001). A significant association exists between poor subjective sleep quality and heightened aggression in this cohort, when all our confounders are controlled, identifying sleep quality as a potential target in treating adolescent aggression.

Peripheral oxytocin levels are linked to hypothalamic gray matter volume in autistic adults: a cross-sectional secondary data analysis

Oxytocin (OXT) is known to modulate social behavior and cognition and has been discussed as pathophysiological and therapeutic factor for autism spectrum disorder (ASD). An accumulating body of evidence indicates the hypothalamus to be of particular importance with regard to the underlying neurobiology. Here we used a region of interest voxel-based morphometry (VBM) approach to investigate hypothalamic gray matter volume (GMV) in autistic (n = 29, age 36.03 ± 11.0) and non-autistic adults (n = 27, age 30.96 ± 11.2). Peripheral plasma OXT levels and the autism spectrum quotient (AQ) were used for correlation analyses. Results showed no differences in hypothalamic GMV in autistic compared to non-autistic adults but suggested a differential association between hypothalamic GMV and OXT levels, such that a positive association was found for the ASD group. In addition, hypothalamic GMV showed a positive association with autistic traits in the ASD group. Bearing in mind the limitations such as a relatively small sample size, a wide age range and a high rate of psychopharmacological treatment in the ASD sample, these results provide new preliminary evidence for a potentially important role of the HTH in ASD and its relationship to the OXT system, but also point towards the importance of interindividual differences.

Case-Finding for Sarcopenia in Community-Dwelling Older Adults: Comparison of Mini Sarcopenia Risk Assessment with SARC-F and SARC-CalF.

We compared the diagnostic performance of the short five-item and full seven-item Mini Sarcopenia Risk Assessment Questionnaire (MSRA-5 and MSRA-7) against the Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F) and SARC-F with calf circumference (SARC-CalF) scales for sarcopenia in healthy community-dwelling older adults. We conducted a post-hoc cross-sectional secondary data analysis of a prospective cohort study, using data from 230 older adults (mean age 67.2±7.4 years, 92% Chinese, and 73% female) from the "Longitudinal Assessment of Biomarkers for characterization of early Sarcopenia and Osteosarcopenic Obesity in predicting frailty and functional decline in community-dwelling Asian older adults Study" (GeriLABS-2) conducted between December 2017 and March 2019 in Singapore. We performed receiver operating characteristic curve analysis to ascertain the area under the curve (AUC) for sarcopenia diagnosis using the Asian Working Group for Sarcopenia 2019 consensus criteria. We applied the Delong method to compare the AUCs of the four instruments. The MSRA-5 and MSRA-7 demonstrated poor diagnostic performance (AUC of 0.511, 95% confidence interval [CI] 0.433-0.589 and AUC of 0.526, 95% CI 0.445-0.606, respectively), compared to that in SARC-CalF (AUC of 0.739, 95% CI 0.671-0.808) and SARC-F (AUC of 0.564, 95% CI 0.591-0.636). The SARC-CalF demonstrated significantly superior discriminatory ability compared to that in the SARC-F, MSRA-5, and MSRA-7 (all p&lt;0.01). The MSRA-5 demonstrated lower sensitivity (0.464) and specificity (0.597) than in the SARC-CalF (0.661 and 0.738, respectively), whereas the MSRA-7 had higher specificity (0.887) and lower sensitivity (0.145). Conclusions: The poor diagnostic performances of the MSRA-5 and MSRA-7 in our study suggest limitations of self-reported questionnaires for assessing general and dietary risk factors for sarcopenia in healthy and culturally diverse community-dwelling older adults. Studies in different populations are needed to ascertain the utility of the MSRA for the community detection of sarcopenia.

Frail older people with decreased cognition can perceive reduced self-determination in self-care and social relationships

BackgroundSelf-determination in old age is essential for people’s experiences of good subjective health and quality of life. The knowledge concerning how frail older people with decreased cognition perceive their ability to be self-determined in the different dimension in daily life is, however, limited. The aim of this study was therefore to explore the relationship of self-determination and cognition in frail older people.MethodsThis study was a cross-sectional secondary data analysis using baseline data with 119 frail people 75 ≥ from a larger randomized control trial. Self-determination was measured with the statements from the Impact on Participation and Autonomy-Older persons (IPA-O). Cognition was measured using the Mini Mental State Examination (MMSE), where decreased cognition was broadly defined as a score below 25 points. Fisher’s exact test was used to test differences in proportions of perceiving self-determination in relation to cognition. The Relative Risk (RR) with a 95% Confidence Interval (CI) was used to explore the risk of perceiving reduced self-determination in relation to cognitive functioning.ResultsNearly the entire study population, regardless of cognitive functioning, perceived self-determination in Financial situation. For people with decreased cognition, the relative risk for perceiving reduced self-determination was statistically significant higher in activities related to Self-care and in Social relationships when comparing with the participants with intact cognition.ConclusionPerceiving self-determination when being old, frail and having decreased cognition is possible but is dependent upon which activities that are involved. Organizing healthcare needs according to the older people’s wants and wishes is crucial regardless of people having a cognitive decline or not when the effort is to enable the people to be as self-determined as they want. The frail older people with decreased cognition should be treated as being experts in their own lives, and healthcare professionals should navigate the older people to get to their desired direction.Trial registrationClinicalTrials.gov, NCT02773914. Retrospectively registered 16 May 2016.

Characterizing telehealth use in the US: analysis of the 2022 Health Information National Trends Survey.

Use of telehealth has been on the rise since the start of the COVID-19 pandemic. Although there has been much investigation of telehealth use in the context of replacing in-person visits, there has been limited study of patients' motivations for using telehealth. The objectives of this study were to (1) evaluate patient characteristics associated with telehealth use and (2) evaluate patients' motivations for using telehealth. We conducted a cross-sectional secondary data analysis of the 2022 nationally representative Health Information National Trends Survey. We conducted logistic regression models estimating the relationship between demographic and health characteristics and (1) use of telehealth services in the previous 12 months and (2) each of 5 motivations for using telehealth among telehealth users. The most common reason for using telehealth was recommendation or requirement by a clinician (73.6%). Respondents with depression were more likely to use telehealth than those without depression (OR, 2.73; P < .001) and were more likely to be motivated by convenience (OR, 1.80; P < .01), and Hispanic respondents were more likely to use telehealth to avoid exposure to infection (OR, 1.58; P < .05). Identifying patients' motivations may help decision makers better understand the perceived value of telehealth among patients and may help policy makers and administrators create opportunities for increased patient choice around visit modality to maximize health care access, value, and quality. Consideration of patient motivations for telehealth use may support practitioners in making tailored and person-centered decisions when recommending telehealth vs in-person visits.