Different Dimensions Of Access Research Articles

Navigating Social Services from the Perspective of Finnish Older Adults with Complex Needs: An Examination of Different Dimensions of Access

This study aims to increase understanding of accessing social services for older adults with complex needs. Individual interviews (18) with older clients of gerontological social work and diaconal social work in Finland were analyzed using abductive content analysis. The conceptual framework of access to services, consisting of five interrelated dimensions by Penchansky and Thomas (1981) and the sixth dimension, awareness, by Saurman (2016), was used as a basis for analysis and reporting of results. The findings showed that accessing services was affected by all six dimensions and factors related to both the service system and the clients. The main results showed that available services did not always meet the needs of older adults (Availability), or they did not have enough information about the services (Awareness). Attitudes toward both the service system and older adults affected their experiences (Acceptability), as well as the perceived approachability of the services (Accommodation). In addition, mobility of services and physical abilities of clients (Accessibility), together with the perceived worth of services in relation to their cost (Affordability), influenced older adults’ access to services. Overall, this study emphasizes the significance of considering different aspects of access in service design and policies for services for older adults.

Socioeconomic inequalities in hospital access for prostate cancer before and after COVID-19

Prostate cancer is one of the most common cancers with 36,016 registered cases in 2020 in the United Kingdom. Access to cancer care remains a policy priority across OECD countries, but there are concerns that socioeconomic inequalities have been amplified following the COVID-19 pandemic due to accumulated backlogs. Using administrative data from the Hospital Episodes Statistics, this study examines socioeconomic inequalities in different dimensions of access to prostate cancer surgery in England in 2015–22, and whether such inequalities increased after COVID-19. Access is a multifaceted concept encompassing several dimensions along the patient pathway. We investigate socioeconomic inequalities in the volume of surgeries, waiting time of patients on the list (patient responsiveness), hospital length of stay (intensity of care), 30-day emergency readmissions and 3-year mortality (health outcomes). We find that, after controlling for a range of factors (e.g. age composition, ethnicity, rurality, primary care availability), the number of prostate surgeries for the most income-deprived quintile is 41.0 % lower than the least income-deprived quintile in the pre-COVID period. The gradient appears similar in the post-COVID period in proportionate terms when volume dropped. We generally find no evidence of inequalities in other dimensions of access, such as waiting times (from patient addition to treatment list) and length of stay (from hospital admission to discharge). We also find no evidence of inequalities in the probability of being readmitted as an emergency within 30 days from discharge. Instead, patients in the most income-deprived quintile have a higher mortality rate by at least one percentage point relative to the least-deprived quintile. This difference in mortality does not appear to be related to differences in the quality of care across hospitals. The analysis highlights the need to take a multidimensional approach when assessing socioeconomic inequalities in access to hospital care along the patient pathway.

Access and continuity of care in primary healthcare (Embase).

Abstract Background: Over the past 20 years, there has been a policy drive in the UK to improve patients' access to appointments in primary care. It has been suggested that this increased focus on timely access to care could hinder continuity of care. The aim of this paper was to investigate how continuity of care and access to care are interrelated and their relative importance for patients and healthcare professionals. Methods: A systematic review was conducted using six academic databases (EMBASE, PubMed, Scopus, Web of Science, CINAHL and PsycINFO). In addition, reference lists of included studies and Google Scholar were searched for additional papers. Fifty-one papers were identified for inclusion in the review. Studies varied in terms of whose perspectives on continuity and access were sought, how they conceptualised access and continuity, and for quantitative studies, what measures used. We conducted a thematic analysis of the literature and used Haggerty et al.'s (2003) conceptualization of continuity and Boyle et al.'s (2020) conceptualization of access to synthesise the data. We used these findings to propose a theorisation of the access-continuity relationship. Findings: Five themes emerged from the synthesis of existing literature: system-level, practice-level and patient-level factors that influence access and continuity of care, what is important to patients, and how practices can support access and continuity of care in general practice. We found that 'choice of access' has the strongest relationship with relational continuity, however, 'physical access', in terms of the ability to get and attend an appointment (in person or remote), supersedes other dimensions of access as necessary but not sufficient for continuity of care. Conclusions: Our synthesis provides evidence that the dimensions of continuity important to patient care depend on the combination of patients' demographic characteristics and health conditions along with situational circumstances including characteristics of the health system and provider, which may be more or less changeable. We present a theoretical framework that accounts for the relationships between the different dimensions of access and continuity that can support policymakers and providers in understanding how to achieve an effective balance in providing both access and continuity for patients.

The notion of access to health care in a large-scale social health protection initiative: a case study of ‘Sehat Sahulat Programme’ at Khyber Pakhtunkhwa, Pakistan

Background Sehat Sahulat Programme (SSP), a health insurance initiative, was launched by the Government of Khyber Pakhtunkhwa (GoKP) in Pakistan to improve access to quality health services. In this paper, we describe the notion of access under SSP, present stakeholders’ views on access-related challenges, and suggest ways forward to realise SSP’s access-related objective in the broader context of its contribution towards Pakistan’s drive to achieve Universal Health Coverage (UHC). Methods We employed a case study design approach using three data sources. We used official GoKP programme documents to capture the chronology of events (policy interventions), in-depth interviews to explore the drivers behind the events and non-participant observations to understand the decision-making and implementation processes. We employed maximum variation sampling. Access to documents and observation sites was gained through the SSP director. We recruited interviewees through direct and indirect approaches and conducted thematic analysis. Findings GoKP engaged the State Life Insurance Corporation (SLIC) of Pakistan as a purchaser. SLIC purchased services from public and private hospitals for SSP patients, up to 600,000 Pakistani Rupees (PKR) per family per year. Considering this insurance coverage, GoKP officials claimed SSP made health care accessible, which the development partners contested. Instead of the narrow finance-centric definition by GoKP, the development partners highlighted the broader dimensions of access, including the services’ acceptability and availability. Tensions existed between the interpretation of the stakeholders on different dimensions of access. For instance, GoKP and SLIC claimed that including private hospitals in SSP improved services’ availability, but development partners noted an under-supply of private providers in remote districts of the province. Bridging such an undersupply, SLIC made inter-district referrals, which the patient advocates noted led to travel costs and geographical barriers. Similarly, GoKP officials claimed SSP had good acceptability. The providers noted that SSP’s acceptability was damaged by limited patient choice, low package rates, and delayed claims payments. Conclusions This analysis suggests that SSP had challenges with the acceptability and geographical dimensions of access which GoKP needed to address. A key transferrable lesson is that demand-side intervention (insurance) might not improve access with a weak supply side. Therefore, countries contemplating improving access to services enroute to achieving UHC need to address both supply and demand-side considerations.

Enhancing Access to Digital Culture for Vulnerable Groups: The Role of Public Authorities in Breaking Down Barriers.

This article discusses which barriers hamper access to, and participation in, cultural life for members of vulnerable groups, in particular persons belonging to old and new minorities and persons with disabilities in the context of digitization. It then examines what role public authorities can play in addressing and dismantling these barriers. The article adopts a bottom-up approach, in that it is based on a qualitative study, which gives voice to vulnerable groups. The qualitative research involved interviews with different organisations representing, or working with, vulnerable groups in 12 European Union Member States (Belgium, Croatia, Denmark, Estonia, Finland, France, Germany, Hungary, Ireland, Italy, Malta and Spain). In that regard, the article approaches vulnerability from a distinct conceptual standpoint, identifying vulnerability as a condition caused by structural barriers. On the whole, the article shows that, while digitization of cultural content, goods and services, offers increased opportunities for culture to be democratised and for its consumption by wider and more varied audiences to be enhanced, it also engenders structural barriers and creates additional challenges. Furthermore, while digitisation has ensured more diverse representation in cultural content, vulnerable groups still face stereotypical and negative portrayals within mainstream cultural content. The thematic analysis of the qualitative interviews also captures different dimensions of access to digital cultural and supports the identification of effective policy measures to bridge the 'digital divide' and assist in the fulfilment of cultural rights of vulnerable groups.

Barriers to accessing health care for people with chronic conditions: a qualitative interview study

BackgroundThere is a growing interest in redesigning healthcare systems to increase access to and coordination across care settings for people with chronic conditions. We aim to gain a better understanding of the barriers faced by (1) children with chronic bronchial asthma, (2) adults with non-specific chronic back pain, and (3) older people with pre-existing mental illness/es in Austria’s fragmented social health insurance system.MethodsUsing a qualitative design, we conducted semi-structured interviews face-to-face and by telephone with health service providers, researchers, experts by experience (persons with lived/ personal experience, i.e., service users, patient advocates or family members/carers), and employees in public health administration between July and October 2019. The analysis and interpretation of data were guided by Levesque’s model of access, a conceptual framework used to evaluate access broadly according to different dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability, and appropriateness.ResultsThe findings from the 25 expert interviews were organised within Levesque’s conceptual framework. They highlight a lack of coordination and defined patient pathways, particularly at the onset of the condition, when seeking a diagnosis, and throughout the care process. On the supply side, patterns of poor patient-provider communication, lack of a holistic therapeutic approach, an urban-rural divide, strict separation between social care and the healthcare system and limited consultation time were among the barriers identified. On the demand side, patients’ ability to perceive a need and to subsequently seek and reach healthcare services was an important barrier, closely linked to a patient’s socio-economic status, health literacy and ability to pay.ConclusionsWhile studies on unmet needs suggest a very low level of barriers to accessing health care in the Austrian context, our study highlights potential ‘invisible’ barriers. Barriers to healthcare access are of concern for patients with chronic conditions, underlining existing findings about the need to improve health services according to patients’ specific needs. Research on how to structure timely and integrated care independent of social and economic resources, continuity of care, and significant improvements in patient-centred communication and coordination of care would be paramount.

Patient perspectives on hypertension management in health system of Sri Lanka: a qualitative study

IntroductionUncontrolled hypertension is the leading risk factor for mortality globally, including low-income and middle-income countries (LMICs). However, pathways for seeking hypertension care and patients’ experience with the utilisation of health...

The influence of registered nurses and nurse practitioners on patient experience with primary care: results from the Canadian QUALICO-PC study

Nurses, whether registered nurses (RNs) or nurse practitioners (NPs), are becoming key providers of primary care services. While evidence for the influence of NPs on patient experience in primary care is mounting, this is less so for RNs. We use the Canadian component of the international Quality and Costs of Primary Care 2013/14 survey to investigate the mechanisms by which nurses can affect patients’ experience in primary care, focusing on accessibility and appropriateness of care. The data allow us to distinguish between family practice RNs, specialised RNs and NPs, and covers all types of patients visiting a primary care clinic in a variety of contexts in all Canadian provinces. In addition to the types of nurses and full-time equivalent (FTE) numbers, we explore the role of nurse autonomy and collaboration. Our regression results show that one of the most important predictors of patient experience is the collaboration between health professionals, whereas nurse staffing in terms of FTE numbers has little influence by itself. Different types of nurses influence different dimensions of accessibility, and the association between patient experience and nurse staffing depends on the number of physicians in the clinic. Our results can inform decision-makers on how to strengthen primary care provision, and particularly in Canadian context, the adaptation of the recently implemented interprofessional primary care teams.

TRAINING RETURN-ON-INVESTMENT: SUATU PERSPEKTIF DALAM MENGEVALUASI KEEFEKTIFAN PROGRAM PELATIHAN

<p><em>Every year new challenges emerge in the field of training and development, for example, competency development, outsourcing, e-learning, and knowledge management. The purpose of this study is to conceptualize the different dimensions of access to employee development. The concept of Kirkpatrick’s Four-Level Framework can be used to choose which levels are appropriate in evaluating a training program. Lilly’s Four Steps of Computing ROI training can also be adapted to the ROI calculation process. The main issue, in the pursuit of profitability and competitive advantage, top management is looking at all functions for a return-on-investment. The main question is, “is it really the training program itself that affects the employee performance?” This research uses ‘time series with comparison group’ technique as a tool to isolate the effects of training. Once the isolation is completed, the ROI calculation can be analyzed then.</em><strong></strong></p><p><em> </em></p><p><strong><em>Keywords</em></strong><em>: Effectiveness of training; isolating the effects of training; time series with comparison group; ROI calculation.</em></p>

Elements of Access: The Effects of Food Outlet Proximity, Transportation, and Realized Access on Fresh Fruit and Vegetable Consumption in Food Deserts.

This study surveys 900 supplemental nutrition assistance program recipient or eligible households and 300 supplemental nutrition assistance program ineligible households in local food deserts to identify the effects of different dimensions of access on fresh fruit and vegetables (FFV) consumption. While proximity and access to one's own car were not significant predictors of FFV consumption, realized access to nonsupermarket outlets did have a positive effect on fresh vegetable consumption. Among food insecure respondents, limited car access had a negative effect on FFV consumption. This research underlines the importance of focusing on dimensions of access other than proximity when considering interventions designed to improve nutrition and health outcomes in food deserts.

Health Citizenship and Access to Health Services: Finland 1900–2000: Table 1.

By analysing access to health services, this paper explores the formation of health citizenship in Finland in the twentieth century. Health citizenship is seen as a part of social citizenship, which emphasises the citizen’s rights to social security. The article constructs four different historical layers of health citizenship, each of which emphasise different dimensions of accessibility and involve different inclusive and exclusive tensions. The article shows the change of focus from promoting the acceptability of medical knowledge and health services, to regional availability of the services in the 1920s–1950s, and to universal affordability in the 1960s–1980s. The reforms of the 1990s respond to a new logic of individual responsibility and result in increasing hierarchies of health citizenship. Elements of the previous historical layers still have a presence in the contemporary health care. Finnish development indicates the interconnectedness of civil, political and health citizenship.

Improving access: modifying Penchansky and Thomas's Theory of Access.

Access is defined as the degree of fit between the user and the service; the better the fit, the better the access. Using the theory developed by Penchansky and Thomas, access is optimized by accounting for the different dimensions of access: accessibility; availability; acceptability; affordability; and adequacy in service design, implementation and evaluation. These dimensions are independent yet interconnected and each is important to assess the achievement of access. However, I argue that one dimension is missing - awareness. I propose that awareness is integral to access, that it should become a permanent part of the theory, and be applied whenever using the theory to develop, implement, or evaluate health care services and access more generally.

The quality versus accessibility debate revisited: A contingency perspective on human information source selection

Previous studies have not fully investigated the role of source accessibility versus source quality in the selection of information sources. It remains unclear what their (relative) importance is. Three different models have been identified: (a) an exclusively accessibility‐driven model, (b) a cost‐benefit model in which both accessibility and quality are significant influences, and (c) an exclusively quality‐driven model. Moreover, the conditions under which accessibility and quality are important are not well understood. The goal of our study is to shed more light on both issues by assessing the role of different dimensions of accessibility and quality and how their importance is affected by time pressure. We conducted a policy‐capturing study in which 89 financial specialists participated. Each judged 20 scenarios in which the accessibility and quality of human information sources, as well as time pressure, were manipulated. Results showed that both accessibility and quality affect the likelihood of asking a human information source for information. Moreover, although the weights attached to physical accessibility and the source's perceived technical quality were indeed moderated by time pressure, in both conditions we find support for a cost‐benefit model of information seeking, in which both accessibility and quality are significant influences.

Location of logistics companies: a stated preference study to disentangle the impact of accessibility

Due to the globalization and the fragmentation of industrial production processes, the logistics sector, organizing the linkages between different production plants and the market, is growing fast. This results in an increasing demand for suitable new business locations. Previous research has indicated that accessibility is a key factor in the location decision making process. Though the literature on this subject is extensive, little research has been done to quantify the impact of the different dimensions of accessibility on the location decision process of logistics companies. This paper aims to fill this void in the literature by means of a revealed preference study (using a Geographic Information System (GIS) analysis) and a stated preference study (using a designed discrete choice experiment) in Flanders (Belgium). The results of the revealed preference study served as input to the design of the choice situations in the stated preference study. In the stated preference study, the respondents were confronted with a series of choice situations described by means of accessibility variables as well as land rent information. An analysis of the resulting data by means of discrete choice modeling revealed that land rent is the most important factor in the location choice of logistics companies in Flanders. Access to a port is the second most important factor, followed by access to a motorway, the location in a business park and an inland navigation terminal, which are all about equally important. Access to a rail terminal plays no significant role in the location choice of logistics companies in Flanders.

Which dimensions of access are most important when rural residents decide to visit a general practitioner for non-emergency care?

Access to primary healthcare (PHC) services is key to improving health outcomes in rural areas. Unfortunately, little is known about which aspect of access is most important. The objective of this study was to determine the relative importance of different dimensions of access in the decisions of rural Australians to utilise PHC provided by general practitioners (GP). Data were collected from residents of five communities located in 'closely' settled and 'sparsely' settled rural regions. A paired-comparison methodology was used to quantify the relative importance of availability, distance, affordability (cost) and acceptability (preference) in relation to respondents' decisions to utilise a GP service for non-emergency care. Consumers reported that preference for a GP and GP availability are far more important than distance to and cost of the service when deciding to visit a GP for non-emergency care. Important differences in rankings emerged by geographic context, gender and age. Understanding how different dimensions of access influence the utilisation of PHC services is critical in planning the provision of PHC services. This study reports how consumers 'trade-off' the different dimensions of access when accessing GP care in rural Australia. The results show that ensuring 'good' access requires that policymakers and planners should consider other dimensions of access to services besides geography.

Evaluating accessibility to Bangkok Metro Systems using multi-dimensional criteria across user groups

Metro systems act as fast and efficient transport systems for many modern metropolises; however, enhancing higher usage of such systems often conflicts with providing suitable accessibility options. The traditional approach of metro accessibility studies seems to be an ineffective measure to gage sustainable access in which the equal rights of all users are taken into account. Bangkok Metropolitan Region (BMR) transportation has increasingly relied on the role of two mass rapid transport systems publicly called “BTS Skytrain” and “MRT Subway”, due to limited availability of land and massive road congestion; however, access to such transit arguably treats some vulnerable groups, especially women, the elderly and disabled people unfairly. This study constructs a multi-dimensional assessment of accessibility considerations to scrutinize how user groups access metro services based on BMR empirical case. 600 individual passengers at various stations were asked to rate the questionnaire that simultaneously considers accessibility aspects of spatial, feeder connectivity, temporal, comfort/safety, psychosocial and other dimensions. It was interestingly found by user disaggregated accessibility model that the lower the accessibility perceptions—related uncomfortable and unsafe environment conditions, the greater the equitable access to services, as illustrated by MRT — Hua Lumphong and MRT — Petchaburi stations. The study suggests that, to balance the access priorities of groups on services, policy actions should emphasize acceptably safe access for individuals, cost efficient feeder services connecting the metro lines, socioeconomic influences and time allocation. Insightful discussions on integrated approach balancing different dimensions of accessibility and recommendations would contribute to accessibility-based knowledge and potential propensity to use the public transits towards transport sustainability.

Abstract A90: Redefining access: A mixed-methods approach to evaluating access to appropriate cancer services for underserved limited English-proficient populations

Abstract Background: In the most diverse state in the country and home to the largest Asian and Hispanic populations of any state, California has a high proportion of the country's Asian cancer deaths (43%) and Hispanic deaths (28%). Early detection with mammography screening is essential, enabling timely treatment and reducing breast cancer mortality. Despite improvements for the general population, the screening rates of minority women, especially those with limited English-proficiency (LEP), remain lower than the average. Previous investigations have shown that multiple barriers impede access to health services for minority immigrants including SES, discrimination, cultural and linguistic factors. More recently studied is the role of geography on access: a sparse literature suggests that the locations of mammography facilities are not equitably distributed to meet the need of underserved populations. Moreover, residents of socially disadvantaged neighborhoods have to travel a greater distance. This paper uses a sequential mixed-methods design to provide a rich understanding of access to mammography services for low-income LEP women. Methods: The first component is a quantitative study that evaluates geographic access among uninsured, low-income women participating in Every Woman Counts (EWC), a California statewide free breast cancer screening program. Two primary data sources were used: (1) phone survey information collected from EWC-participating mammography facilities about their interpreter/language services (n=196), and (2) sociodemographic data including primary language and residential address of EWC-eligible participants, 2007–2008 (n=15,199). Network street distances were computed to determine the average distance of participants to the nearest EWC facility and to the nearest language-concordant facility. The second is a qualitative case study of low-income LEP Chinese women living in Oakland. We employed a grounded theory approach to broadly inquire about the Chinese experience in seeking mammography services. In-depth interviews (n=20) were conducted in Chinese; transcripts were coded and content analyzed for relevant themes. Results: Most facilities reported having language/interpreter services available for patients obtaining mammography screening (84%) though 16% reported none. Use of bilingual staff was most common (90%) followed by professional interpreters (58%). Of the 15,199 EWC participants, 56% reported English as their primary language, 40% Spanish, and 4% Asian language (Cantonese, Mandarin, Korean, or Vietnamese). The average distance individuals must travel to reach the nearest facility is 8 miles. Monolingual Asian women must travel further for language-concordant services than those who speak Spanish or English. The spatial study findings suggest a gap corresponding to the distribution of language-appropriate cancer screening facilities and the language needs of low income and uninsured women requiring mammograms. The qualitative study revealed a dynamic interaction between language access, geography, and perceived quality care influencing women's decision on where to go for mammography. Although only two mammography facilities are available for low-income Oakland residents, Chinese women consider these three factors in citing preference for one location over the other. Transportation challenges are exacerbated by language barriers and older age. Easy access to affordable and quality cancer screening services is important for all populations but particularly to those with significant language barriers. Limited English-proficient women have low geographic access to language-appropriate services. Language, geography, and perceived quality care are intertwined in a complex way to influence the choice of providers. This paper addresses the different dimensions of access and can inform allocation of resources to increase accessibility to low-income immigrant populations. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A90.

Gambling Accessibility: A Scale to Measure Gambler Preferences

Geographic closeness of gambling venues is not the only aspect of accessibility likely to affect gambling frequency. Perceived accessibility of gambling venues may include other features such as convenience (e.g., opening hours) or "atmosphere". The aim of the current study was to develop a multidimensional measure of gamblers' perceptions of accessibility, and present evidence for its reliability and validity. We surveyed 303 gamblers with 43 items developed to measure different dimensions of accessibility. Factor analysis of the items produced a two factor solution. The first, Social Accessibility related to the level at which gambling venues were enjoyed because they were social places, provided varying entertainment options and had a pleasant atmosphere. The second factor, Accessible Retreat related to the degree to which venues were enjoyed because they were geographically and temporally available and provided a familiar and anonymous retreat with few interruptions or distractions. Both factors, developed as reliable subscales of the new Gambling Access Scale, demonstrated construct validity through their correlations with other gambling-related measures. Social Accessibility was moderately related to gambling frequency and amount spent, but not to problem gambling, while, as hypothesised, Accessible Retreat was associated with stronger urges to gamble and gambling problems.

Access and choice – competition under the roof of solidarity in German health care: an analysis of health policy reforms since 2004

This paper analyses the influence of recent German health care reforms, the Statutory Health Insurance Modernization Act 2004 and the Statutory Health Insurance Competition Strengthening Act 2007, on different dimensions of access and choice. More specifically, we look at and discuss the effects of these policies on the availability, reachability and affordability of health care as well as on their impact on consumers' choice of insurers and providers. Generally, patients in Germany enjoy a high degree of free access and a lot of freedom to choose, partly leading to over- and misuse of health services. Concerning choice of insurers, one result of our analysis is that in the statutory health insurance system, the introduction of a greater variety of benefit packages will develop into an additional parameter of choice. In contrast to that, insurees more and more accept certain restrictions of choice and direct access to providers by enrolling into new forms of care (such as gatekeeping-, disease management- and integrated care programmes). However, they might benefit from better quality of care and more options for products and services that best fit their needs.

Measuring Access to Eye Care: A Public Health Perspective

Purpose: To examine the different dimensions of access to eye care from a public health perspective. Methods: We substantively review the theoretical and empirical literature on access to eye care and summarize the major considerations in measuring access to eye care using a modified behavioral framework. Results: We found that progress has been made, but some gaps still remain in measuring access to eye care. Most studies have focused on individual characteristics and use of eye care services. Only a very few studies have touched on contextual characteristics, such as demographic make-up of the area in which the patient lives, and their impact on the use of eye care services. Few studies have explored the linkage between the use of eye care services and outcomes or between the use of such services and patient satisfaction. Conclusions: To address a variety of demands from patients, providers, and policy makers, it is necessary to account for potential access and realized access measures. We need to adopt new methods in assessing the relationship between contextual characteristics and use of eye care services. Moreover, we need to better understand patients' satisfaction and their relationship with utilization and health outcomes.