Difficulty Accessing Health Services Research Articles

The postpartum period during the COVID-19 pandemic: investigating Turkish women’s postpartum support and postpartum-specific anxiety

This study aimed to examine how Turkish women were affected by the COVID-19 pandemic in the postpartum period in terms of postpartum support and anxiety variables. The study was conducted with 130 women who gave birth during the COVID-19 period. Data were collected online using a personal information form, Postpartum Support Scale and Postpartum Specific Anxiety Scale. Descriptive statistics were used, with Kruskal-Wallis and regression analysis performed. All postpartum women stated that they were affected negatively by COVID-19. The most common issues described were feeling alone (25.51%), having economic difficulties (15.5%) and experiencing difficulties accessing health services (21.7%). The mean Postpartum Support Scale score was 102.43±27.67, while the mean Postpartum Specific Anxiety Scale score was 188.07±96.71. COVID-19 exposure level had a significant effect on postpartum-specific anxiety (p=0.00). The variables of having a problem during pregnancy (p=0.006), having a baby willingly (p=0.007), and partner's educational status significantly predicted the degree of being affected by COVID-19 (p=0.025). The degree to which COVID-19 affected the women was determined by having problems during pregnancy, having a baby willingly, and a highly educated partner. These variables may inform a resource to empower postpartum women during COVID-19. Healthcare systems need to be organised considering pandemic conditions to provide increased postpartum support, evaluate psychological health, deliver healthcare services, and consider pregnancy periods.

The door is open, but not everyone may enter: racial inequities in healthcare access across three Brazilian surveys.

Health policies in Brazil have sought to expand healthcare access and mitigate inequities, but recent revisions of their content have weakened the Brazilian Unified Health System. This study estimates three healthcare indicators across three national surveys conducted in 2008, 2013, and 2019 to assess the impact of changes to the National Primary Care Policy on racial inequities in healthcare. Considering the survey design and sampling weights, we estimated the prevalence of each outcome among both whites and Blacks for the whole country, and according to the Brazilian regions. We test the following hypotheses: compared to whites, Blacks showed higher frequency of coverage by the Family Health Strategy, lower frequency of health insurance coverage, and higher frequency of perceived difficulty accessing health services (H1); Racial inequities decreased in the ten-year period but remained constant between 2013-2019 (H2); Racial gaps have widened among regions with lower proportions of Blacks (H3). Our findings fully support H1, but not H2 and H3. Racial inequities either remained constant or decreased in the 2013-2019 period. By downplaying the importance of the universality and equity principles, the latest revision of the National Primary Care Policy has contributed to the persistence of racial inequities in healthcare.

The Experience of Indonesian Migrant Workers in Taiwan during Covid-19 Pandemic: A ‘right-based’ Analysis

Covid-19, which has attacked the world since the end of 2019, has had a global impact both economically and socially to the world community. Taiwan is one of country categorized as quite successful in dealing with Covid-19. From December 2019 until March 2021 there were 177,578 reported cases in Taiwan with a total of 976 positive cases and resulted in 10 deaths. A very small number compared to other cases that occur in other parts of the world. However, behind all that successful story, migrant workers in Taiwan are still forgotten during the pandemics. Migrant workers, particularly Indonesian migrant workers, who make up the majority in Taiwan, receive the least sympathy and understanding from the community. Several human rights issues confronted Indonesia Migrant Workers during the Covid-19 pandemic, including discrimination, loss of spatial public space, strict mobility limitations, concern for the family in Indonesia, a higher burden of common mental health, and a lower quality of life than local society, difficulty accessing health services and masks, and difficulty returning home. The purpose of this paper is to demonstrate how Indonesian migrant workers' rights were violated in Taiwan during the two phases of the Covid-19 pandemic. The data was collected through interviews, observation, and then was analyzed using the "rights-based" approach. The first phase lasted from December 2019 to March 2020, when the pandemic was still in its early stages, and the second phase lasted from March 2020 to January 2021, after the Taiwan government succeeded in controlling the pandemic

POIS-10 Māori: Outcomes and Experiences in the Decade Following Injury.

Injury-related disability burden extends well beyond two years post-injury, especially for Māori (Indigenous) New Zealanders. Māori also experience greater difficulty accessing health services. This prospective cohort study extension uses mixed-methods and aims to understand and identify factors contributing to long-term experiences and outcomes (positive and negative) at 12 years post-injury for injured Māori and their whānau (families), and explore the barriers and facilitators to whānau flourishing, and access to health and rehabilitation services. Five hundred and sixty-six Māori, who were injured between 2007–2009, participated in the Prospective Outcomes of Injury Study (POIS). Of these, 544 consented to long-term follow up, and will be invited to participate in a POIS-10 Māori interview at 12 years post-injury. We anticipate a 65% follow-up rate (~n = 350). Aligned with the Meihana Model, interviews will collect information about multiple inter-related dimensions. Administrative injury and hospitalisation data up to 12 years post-injury will also be collected. Regression models will be developed to examine predictors of long-term health and disability outcomes, after adjusting for a range of confounders. POIS-10 Māori will identify key points in the injury and rehabilitation pathway to inform future interventions to improve post-injury outcomes for Māori and whānau, and will highlight the support required for Māori flourishing post-injury.

Barriers to Access to Healthcare Services among Physically Challenged Persons in Gem Sub County, Siaya County, Kenya

Despite Kenya’s commitment to equal access to healthcare for all by the year 2030, and the increase in the number of services provided, physically challenged persons still meet difficulty accessing health services for reasons attributable to different factors. This descriptive cross-sectional study identified existing person-related factors hindering access to healthcare services by the physically challenged persons in Gem Sub-county, Kenya. Stratified and systematic random sampling was used to select 108 physically disabled persons. Data was collected using semi-structured questionnaire and analyzed using SPSS (v23). Descriptive statistics were used to summarize social-demographic and physical attributes of the participants, and x 2 test was used to detect the relationship between relevant variables (α= 0.05). Out of 108 respondents, 65(male=33) had difficulty in accessing healthcare services. Participant gender, education, residential location and average monthly income, unemployment and environment inaccessibility to health facilities were found to significantly influence access of healthcare services (p<0.05). The study highlights the importance of adequate monthly funding, health insurance and measures to ensure the rights of PWPDs to healthcare services are put in place and implemented under legislation and policy. Further research is required to explore ways to remove barriers to access to healthcare.

Mapping the Margins in Health Services Research: How Does Race Intersect With Gender and Socioeconomic Status to Shape Difficulty Accessing HealthCare Among Unequal Brazilian States?

Research on healthcare inequities has centralized whether marginalized racial, gender, or socioeconomic (SES) groups are afforded equitable access to care, yet scant investigations have focused on how race intersects with other social statuses to shape difficulty accessing health services. Contextual specificity has also been under-researched in this field of knowledge. Data from 59,249 respondents 18 years of age and over from the 2013 Brazilian National Health Survey were analyzed using multilevel regressions models. We test 3 hypotheses: racial, gender, and socioeconomically oppressed groupsare each more likely to report difficulty accessing health services (H1); compared to high-SES white men, low-SES Black women report expressively higher frequencies of the outcome (H2); and intersectional healthcare inequities are larger among low-SES Brazilian states (H3). Partially supporting H1 and H2, results suggest that race and SES, but not gender, are each strong predictors of difficulty accessing healthcare, with low-SES Black respondents facing the highest odds of reporting this outcome. Although H3 was not supported, intersectional groups residing in low-SES Brazilian states were more likely to report difficulty accessing healthcare. This study demonstrated that, together with contextual specificity, the intersections of race with other axes of marginalization should be at the forefront of research and policy addressing healthcare inequities.

Consumer perspective from people with a diagnosis of Borderline Personality Disorder (BPD) on BPD management-How are the Australian NHMRC BPD guidelines faring in practice?

Accessible SummaryWhat is known on the subject? Internationally, stigma towards people with mental illness has reduced due to greater understanding, education and advocacy in the community, and more focus on recovery‐oriented care within practice guidelines.However, many people with a diagnosis of BPD continue to experience stigma and difficulty accessing health services. Contributing factors include lack of understanding of BPD and effective management by health professionals, stigma from the general population and within healthcare services, and financial and geographical barriers.Mental health nurses comprise a large part of the healthcare workforce responsible for the day‐to‐day care of people diagnosed with BPD. What the paper adds to existing knowledge This paper investigates how Australian consumer perspectives on BPD management have changed over time. Comments from a large survey, delivered to consumers in 2011 (N = 153) and 2017 (N = 424), were analysed for common themes.Themes were broadly related to NHMRC BPD Guidelines sections released in 2013. These data sets therefore present an opportunity to evaluate changes in consumer perspectives pre‐ and post‐Guideline release. Although no direct causal relationship can be drawn, analysing these changes can potentially assist with understanding the impact of the Guidelines in practice. No such analysis of the Australian Guidelines has been conducted to date in the existing literature. What are the implications for practice? Many people diagnosed with BPD continue to experience stigma, barriers to treatment and difficulty accessing appropriate services.Widespread practical implementation of the Guidelines was not apparent; however, improved general awareness and understanding of BPD from consumers and health professionals were evident. Improved education and practice across each and all aspects of the Guidelines are indicated.The Guidelines need review to ensure they are in‐line with current evidence‐based practice, as well as effective health professional education, support and funding to embed the revised Guidelines into practice. IntroductionInternationally, many individuals diagnosed with BPD continue to experience stigma within health care and are more likely to be viewed as manipulative and evoke negative responses from clinicians, compared with other mental health consumers.Aim/QuestionTo understand Australian consumer perspectives regarding BPD management, and how these have changed between 2011 and 2017. To comment on how NHMRC BPD Guidelines, released 2013, are faring in practice.MethodIndividuals who identified a BPD diagnosis completed a 75‐question survey, delivered online Australia‐wide, in 2011 (N = 153) and 2017 (N = 424), providing comparative data sets to evaluate changes in consumer perspective on BPD management.ResultsMany people diagnosed with BPD experience difficulties when seeking help, stigma within health services and barriers to treatment. Improved general awareness, communication and understanding of BPD from consumers and health professionals were evident.DiscussionConsumers demonstrated increased BPD‐literacy and help‐seeking behaviours in 2017, providing opportunity for health professionals to build stronger therapeutic relationships. Widespread practical implementation of the Guidelines does not appear to have been achieved. More health professional education, updated Guidelines, funding and strategies to embed these Guidelines into practice are needed.Implications for PracticeMental health nurses regularly provide care to people diagnosed with BPD; with practical education and support, they and other health professionals can improve their confidence in practice and provide better quality care to consumers.

Sitting in the waiting room: do people experiencing homelessness underutilize health services?

ABSTRACT Homeless persons tend to have poorer health than the broader population, and thus have a greater need for health services. However, due to resource constraints impeding access to health care, and the chaotic nature of living as a homeless person, this most disadvantaged group may face greater difficulties accessing health services. We use an Australian panel survey, Journeys Home, to contrast health service use by people experiencing homelessness with service use by a similarly vulnerable, yet formally housed group where we can also control for health-related needs. The paper measures the extent to which transitional and enduring homelessness is related to health service usage controlling for differences in health needs; and investigates whether any differences confirm prior research findings which suggest that individuals suffering homelessness are heavy users of support services (e.g., hospital admissions) but light users of primary health services (e.g., general practitioners (GPs) and dentists) that are an important gateway to specialist services.

Older Aboriginal Australians' Health Concerns and Preferences for Healthy Ageing Programs.

While there is strong evidence of the need for healthy ageing programs for older Aboriginal Australians, few are available. It is important to understand older Aboriginal Australians’ perspectives on healthy ageing in order to co-design culturally-appropriate programs, including views on technology use in this context. Semi-structured interviews were conducted with 34 Aboriginal Australians aged 50 years and older from regional and urban communities to explore participants’ health concerns, preferences for healthy ageing programs, and receptiveness to technology. Qualitative data were analyzed using a grounded theory approach. This study found that older Aboriginal Australians are concerned about chronic health conditions, social and emotional well-being, and difficulties accessing health services. A range of barriers and enablers to participation in current health programs were identified. From the perspective of older Aboriginal people, a successful healthy ageing program model includes physical and cognitive activities, social interaction, and health education. The program model also provides culturally safe care and transport for access as well as family, community, cultural identity, and empowerment regarding ageing well as central tenets. Technology could also be a viable approach for program delivery. These findings can be applied in the implementation and evaluation of culturally-appropriate, healthy ageing programs with older Aboriginal people.

Self-medication in patients of the basic health unit of a brazilian city

The objective of the study was to analyze the prevalence of self-medication among users of Basic Health Units in the city of Monte Alegre – Rio Grande do Norte State, Brazil. A descriptive exploratory study was carried out, through the application of structured questionnaires, with 125 people. It was observed that 83% of the interviewees practiced self-medication, of these, 34%, they did it monthly. The main justifications for this practice were: difficulty accessing health services (50%), financial reasons (28%) and lack of time (22%). The most used drugs were: analgesic (63%), anti-inflammatory (13%) and sedative / hypnotic (7.0%). Most (55%) claimed to have no or little knowledge about the meaning of self-medication. This demonstrates the need for health education actions in order to educate the population about the risks of this practice, since it can lead to masking of symptoms of diseases, drug interactions and intoxications that compromise the health of the user. Keywords: Health. Drug. Use.

Negative impacts of COVID-19 lockdown on mental health service access and follow-up adherence for immigrants and individuals in socio-economic difficulties

ObjectivesLockdown measures in response to the coronavirus disease 2019 (COVID-19) pandemic can have serious mental health effects on the population, especially in vulnerable groups, such as those living in poor socio-economic conditions, those who are homeless, migrant workers and asylum seekers/refugees. In addition, these vulnerable groups frequently have greater difficulty accessing health services and in treatment adherence. The aim of this study is to estimate the impact of the COVID-19–related lockdown on service utilisation and follow-up adherence in an Italian mental health outpatient service for migrants and individuals in socio-economic difficulties. Study designThe design of this study is a retrospective cross-sectional study. MethodsAll patients who visited the mental health outpatient service in the months of February and March in the years 2017–2020 were included in the study. To compare service utilisation before and after the lockdown, the number of patients who visited the mental health outpatient service for psychiatric interview were recorded. Follow-up adherence was calculated as the percentage of patients who visited in February and subsequently attended a follow-up visit in March of the same year. ResultsThe number of patients who visited the outpatient service between February 2017 and February 2020 was continuously increasing. In March 2020, fewer patients visited the service for psychiatric interview, in line with the introduction of lockdown measures. In addition, the number of the patients who visited in February 2020 and returned for their follow-up visits in March 2020 declined from approximately 30% over the same months in 2017–2019 to 17.53% in March 2020. ConclusionsThe lockdown-related reduction in numbers of patients accessing the mental health service makes it difficult to help vulnerable populations during a period of time in which their mental health needs are expected to increase. Moreover, the reduction seen in follow-up compliance increases the risk of treatment discontinuation and possible relapse. Proactive alternative strategies need to be developed to reach these vulnerable populations.

2318. Prevalence of Influenza-like Illness in Sheltered Homeless Populations: A Cross-Sectional Study in Seattle, WA

BackgroundIndividuals experiencing homelessness are at an increased risk of respiratory illness due to high prevalence of underlying chronic conditions, inadequate ventilation and crowding in shelters, and difficulty accessing health services. Few studies have investigated the prevalence and transmission of viral respiratory infections within shelters. We sought to determine the prevalence and risk factors for influenza-like illness (ILI) at two homeless shelters in Seattle, WA.MethodsBetween January and April 2019, we conducted a cross-sectional study of adults experiencing homelessness who identified their primary residence as one of the two shelters in Seattle. Participants voluntarily enrolled if they self-reported at least two symptoms of acute respiratory illness in the past week. Demographic, clinical, and behavioral data were ascertained via questionnaire, and a mid-nasal swab was collected. ILI was defined as fever with cough or sore throat. Chronic lung disease was defined as chronic obstructive pulmonary disease, asthma, and/or chronic bronchitis.ResultsAmong the 480 participants enrolled in the study, 204 (42.5%) reported ILI symptoms. Of those enrolled, 144 (30.0%) had chronic lung disease. The prevalence of ILI was higher among individuals with chronic lung disease (53.5% vs. 42.5%, P = 0.001). A total of 422 (87.9%) had health insurance; the prevalence of ILI was lower among those with health insurance (42.4% vs. 57.8%, P = 0.66). 216 (45.0%) of participants received flu vaccine; the prevalence of ILI was similar among those who received the vaccine than those that did not (42.6% vs. 42.4%, P = 1.00). 129 (30.6%) of those with health insurance sought care for their reported symptoms; ILI was more prevalent in those that sought care than those that did not throughout the observation period (33.8% vs. 21.7%, P = 0.002). Of those with ILI that sought care, 46 (54.8%, P = 0.42) received antivirals or antibiotics. Laboratory results for the corresponding mid-nasal swabs are pending.ConclusionA large proportion of our study population self-reported ILI and chronic lung disease. Despite high insurance coverage, a low proportion of homeless enrolled sought care for their symptoms or received treatment. Disclosures All authors: No reported disclosures.

A Community-Based Intervention for the Detection of Chagas Disease in Barcelona, Spain

Chagas disease (CHD) has become a challenge in Spain due to the high prevalence of immigrants coming from endemic areas. One of the main difficulties for its control and elimination is its underdiagnosis. The identification and integral treatment of CHD are key to increasing rates of diagnosis, overcoming psycho-social barriers and avoiding CHD progression. Community interventions with in situ screening have proven to be a useful tool in detecting CHD among those with difficulties accessing health services. To determine the underdiagnosis rate of the population most susceptible to CHD among those attending two different Bolivian cultural events celebrated in Barcelona; to describe the sociodemographic characteristics of the people screened; and to analyse the results of the screening. The community interventions were carried out at two Bolivian cultural events held in Barcelona in 2017. Participants were recruited through community health agents. A questionnaire was given to determine the participants' prior knowledge of CHD. In situ screening was offered to those who had not previously been screened. Those who did not wish to be screened were asked for the reason behind their decision. Results were gathered in a database and statistical analyses were performed using STATA v14. 635 interviews were carried out. 95% of the subjects reported prior knowledge of CHD. 271 subjects were screened: 71.2% women and 28.8% men, of whom 87.8% were of Bolivian origin. The prevalence of CHD was 8.9%. Community health interventions with in situ screening are essential to facilitating access to diagnosis.

Prevalence and factors associated to disclosure of same-sex practices to family members and health care workers among men who have sex with men in Togo

ABSTRACTDisclosure of same-sex practices is associated with improved access to health services and better health outcomes. Our aim was to estimate the prevalence of same-sex practice disclosure to family members and health care workers (HCW) in two cities in Togo. 683 MSM ≥18 years of age were surveyed using respondent driven sampling (RDS) for a cross-sectional survey using a structured questionnaire in Lomé (354 (51.8%)) and Kara (n = 329 (48.2%)). Median age was lower in Lomé than in Kara. A significantly higher proportion of MSM in Lomé (RDSa: 37.0%; 95% CI: 29.7, 44.3) than in Kara (RDSa: 8.0%; 95% CI: 4.7, 11.3) told a HCW that they have sex with men. Disclosure to a family member was associated with female gender, living with HIV, difficulties accessing health services, and blackmail. Disclosure to a HCW was associated with living with HIV, and physical abuse. MSM had decreased odds of disclosure to a HCW if they were living in Kara, reported female gender or intersex, or if had difficulties accessing health services. These data highlight the positive health outcomes associated with disclosure contextualized by the complex environments in which disclosure of same-sex practices takes place.

Prevention of Asbestos Exposure in Latin America within a Global Public Health Perspective.

Background:Asbestos consumption in Latin America (LA) amounts to 10% of yearly global production. Little is known about the impact of asbestos exposure in the region.Objective:To discuss scientific and socio-economic issues and conflicts of interest and to summarize epidemiological data of asbestos health effects in LA.Discussion:Recent data on chrysotile strengthened the evidence of its carcinogenicity and showed an excessive risk of lung cancer at cumulative exposure levels as low as 1.5 fibre-years/ml. Technology for substitution is available for all asbestos-containing products and ceasing asbestos production and manufacturing will not result in unemployment and loss of income, except for the mining industry. The flawed arguments used by the industry to maintain its market, both to the public and in courtrooms, strongly relies on the lack of local evidence of the ill effects and on the invisibility of asbestos-related diseases in LA, due to the limited number of studies and the exposed workers’ difficulty accessing health services. The few epidemiological studies available show clear evidence of clusters of mesothelioma in municipalities with a history of asbestos consumption and a forecasted rise in its incidence in Argentina and Brazil for the next decade. In Brazil, non-governmental organizations of asbestos workers were pivotal to counterbalance misinformation and inequities, ending recently in a Supreme Court decision backing an asbestos ban. In parallel, continuous efforts should be made to stimulate the growth of competent and ethical researchers to convey adequate information to the scientific community and to the general public.

Acesso aos Serviços de Saúde: o que dizem as mulheres privadas de liberdade?

Objetiva-se analisar como as mulheres encarceradas percebem o acesso aos serviços de saúde. Estudo descritivo,exploratório e qualitativo realizado com quarenta mulheres em um presídio feminino do Estado do Rio de Janeiro, Brasil.Foi utilizada na coleta de dados, a entrevista semiestruturada, e posterior transcrição na integra. As entrevistas foramsubmetidas à análise de conteúdo na modalidade temática. Antes e durante o encarceramento, as mulheres referiramdificuldades para acessar os serviços de saúde. Entretanto, surgem falas de modo contraditório, inferindo a possibilidadede, após a entrada no sistema penal, essas mulheres conseguem acessar alguns serviços de saúde jamais visitados antesdo período de confinamento. Conclui-se que para garantir a aplicabilidade da política vigente, existe a necessidade deestratégias de atenção integral à saúde dessas mulheres, que assegurem o acesso aos serviços de saúde numa perspectivaampliada de promoção, prevenção, tratamento e reabilitação, antes, durante e depois da prisão.Palavras-chave: Acesso aos Serviços de Saúde; Assistência Integral à Saúde; Mulheres; Prisões.
 AbstractThe aim is to analyze how incarcerated women perceive access to health services. This descriptive, exploratory andqualitative study was carried out with 40 women in a female prison in the state of Rio de Janeiro, Brazil. It was used indata collection, semi-structured interview, and subsequent transcription in the integrated. The interviews weresubmitted to content analysis in the thematic modality. Before and during incarceration, women reported difficulties inaccessing health services. However, they appear contradictory, inferring the possibility of, after entering the penal system,these women were able to access some health services never visited before the confinement period. It concludes that toensure the applicability of the current policy, there is a need for comprehensive health care strategies for these women,which ensure access to health services in a broader perspective of promotion, prevention, treatment and rehabilitation,before, during and after imprisonment.Keywords: Access to Health Services; Integral Health Assistance; Women; Prisons.

Exercise and physical activity in asylum seekers in Northern England; using the theoretical domains framework to identify barriers and facilitators

BackgroundMany asylum seekers have complex mental health needs which can be exacerbated by the challenging circumstances in which they live and difficulties accessing health services. Regular moderate physical activity can improve mental health and would be a useful strategy to achieve this. Evidence suggests there are barriers to engaging black and minority ethnic groups in physical activity, but there is little research around asylum seekers to address the key barriers and facilitators in this group.MethodsA two stage qualitative study used semi-structured interviews underpinned by the Theoretical Domains Framework. The interviews were conducted in voluntary sector groups in four towns/ cities in Northern England. Purposive sampling recruited 36 asylum seekers from 18 different countries. Interviews were audio recorded, transcribed verbatim and subject to framework analysis. Stage two involved a nominal group technique with five key stakeholders including asylum seekers and those that work with them. They followed a four stage process to rank and reach consensus on the key barrier to undertaking physical activity/ exercise that could be addressed locally through a future intervention.ResultsA number of barriers and facilitators were identified including a lack of understanding of the term physical activity and recommended levels but knowledge of the health benefits of physical activity/ exercise and the motivation to increase levels having engaged with activities back home. Living as an asylum seeker was considered a barrier due to the stress, poverty and temporary nature of living in an unfamiliar place. The outcome of the nominal group technique was that a lack of knowledge of facilities in the local area was the prevailing barrier that could be addressed.ConclusionsPublic health practitioners could develop interventions which capitalise on the motivation and knowledge of asylum seekers to encourage an increase in physical activity which may in turn reduce the breadth and depth of mental health needs of this group.

Health care barriers, racism, and intersectionality in Australia

While racism has been shown to negatively affect health care quality, little is known about the extent to which racial discrimination works with and through gender, class, and sexuality to predict barriers to health care (e.g., perceived difficulty accessing health services). Additionally, most existing studies focus on racial disparities in the U.S. context, with few examining marginalized groups in other countries. To address these knowledge gaps, we analyze data from the 2014 Australian General Social Survey, a nationally representative survey of individuals aged 15 and older living in 12,932 private dwellings. Following an intersectional perspective, we estimate a series of multivariable logit regression models to assess three hypotheses: racial discrimination will be positively associated with perceived barriers to health care (H1); the effect of perceived racial discrimination will be particularly severe for women, sexual minorities, and low socio-economic status individuals (H2); and, in addition to racial discrimination, other forms of perceived discrimination will negatively impact perceived barriers to health care (H3). Findings show that perceptions of racial discrimination are significantly associated with perceived barriers to health care, though this relationship is not significantly stronger for low status groups. In addition, our analyses reveal that perceived racism and other forms of discrimination combine to predict perceived barriers to health care. Taken together, these results speak to the benefits of an intersectional approach for examining racial inequalities in perceived access to health care.

Health and well being of lesbian, gay, bisexual, transgender and intersex people aged 50 years and over.

Objectives The aim of the present study was to examine the health and well being of older lesbian, gay, bisexual, transgender and intersex (LGBTI) people, the health issues that concern them, the services they use and challenges accessing services. Methods This study comprised a survey of the health and well being of 312 LGBTI people aged 50 years and over in New South Wales. The survey included the Short-Form 12 (SF-12) measure of health-related quality of life, the Kessler 10 (K10) measure of psychological distress, and the three-item Loneliness Scale. Results Higher levels of psychological distress, lower mental health and greater loneliness were found among this sample than is typically found in the general population. Mental health was lower among carers and those not in a relationship, while psychological distress was greater among those living alone and those experiencing higher rates of loneliness. The most commonly accessed health service was a general practitioner (GP), with most respondents reporting that they were open about their sexuality to their GP and that they had a regular GP. Some reported difficulties accessing health services because of their gender or sexual diversity. Conclusions Although many older LGBTI people are well, both physically and mentally, they do appear to face increased risk of certain health issues compared with the general population. What is known about the topic? Overseas research indicates that older LGBTI people may be at greater risk of certain physical and mental health conditions than the general population. What does this paper add? This paper provides Australian data, using well-validated instruments, on the health and well being of older LGBTI people. It provides evidence of the health issues that older LGBTI people are most concerned about and the barriers they face in accessing services. What are the implications for practitioners? It is important for health practitioners to be aware that older LGBTI people appear to be at increased risk of certain physical and mental health issues, such as loneliness and psychological distress. Providing opportunities for clients to identify their gender or sexual diversity may assist in monitoring risk factors and enable referral to promote healthy aging.

NU01.05 Indigenous Population with Lung Cancer

NU01.05 Indigenous Population with Lung Cancer