Inequalities In Access Research Articles

P077 The Yorkshire Bone Network- why every region needs a Bone Network!

Abstract Background/Aims The Yorkshire Bone Network (YBN) was formalised in 2019, from a founding group of Yorkshire clinicians with a special interest in osteoporosis, meeting every four months since 1994 to discuss new drugs as they were licensed, the research underpinning them, complex clinical cases and educational topics in osteoporosis. This group was formalised into a Network in order to expand the membership and invite contributions from an increased range of specialists from different disciplines and Trusts across Yorkshire. Further aims were to reach consensus on the management of key osteoporosis issues across Yorkshire and deliver Regional guidelines. Methods The YBN now has 35 members from Rheumatology, Endocrinology, Metabolic Bone and Elderly Medicine departments from 12 different Trusts across Yorkshire. Meetings are four-monthly, continuing on Zoom during the pandemic, and now in-person again. Each meeting involves discussion of complex clinical osteoporosis cases for management decisions, alongside an educational or guidelines development session, delivered by a member of the Network or an invited guest speaker. Results We have: Agreed a consensus statement on the use of Romosozumab in Yorkshire, specifically covering cardiovascular screening for potential patients. This has given clinicians confidence in identifying appropriate patients and prescribing this new drug. This should also ensure equity of drug access to patients across the region, who are being assessed using the same framework. We have written guidelines on the role of bone densitometry in patients with coeliac disease. This has been provided to local Gastroenterologists, with the aim of reducing unnecessary bone densitometry referrals, reducing the burden on patients and radiology departments. We have provided regional recommendations for the early (before 14 days) administration of IV zoledronate for inpatients post fractured neck of femur, avoiding discharge prior to treatment. This has been adopted and is being audited to assess impact in one of our District General Hospitals. We have provided educational sessions on bone turnover markers, FRAXPlus, glucocorticoid-induced osteoporosis and renal bone disease. Conclusion The Yorkshire Bone Network is an excellent example of collaborative working. It is a valuable forum for clinical decision making for complex patients across the region. It has allowed the development of guidelines and consensus statements which are in clinical use, thus minimising variation in patient care across the region and improving clinician confidence. It continues to be an enjoyable way of forming new links between colleagues both within our own Trusts and across the region, with new members joining each year. Time is needed to co-ordinate the meetings, provide minutes and liaise with colleagues but the benefits far outweigh the effort! We would strongly recommend the formation of similar networks across the UK, given the benefits to both patients and clinicians. Disclosure C.Y.J. Vandevelde: None. S. Sultan: None. L. Hordon: None.

A cross-sectional survey of patient attitudes towards telemedicine in head and neck surgical oncology

ObjectiveTo investigate patient attitudes towards desire for and barriers to utilizing telemedicine visits for head and neck oncology care. MethodsThis is a retrospective analysis of data from cross-sectional survey responses collected via prospectively administered questionnaire to 616 adult patients during their clinical visit to a tertiary care head and neck surgical oncology clinic. Responses to questions investigating interest in telemedicine and potential barriers were collated with patient demographics, measures of rurality, and insurance status. Interest in telemedicine appointments was the assessed primary outcome. ResultsOf 616 survey respondents, 315 (51 %) indicated interest in telemedicine visits. Limitations in access to technology (17.5 %) and lack of reliable internet connection (13.14 %) were identified as key barriers to telemedicine use. Lack of interest in telemedicine was associated with older age (OR 0.97 [95%CI 0.96–0.98]), governmental insurance (0.43 [0.31–0.60]) and, retired work status (0.48 [0.33–0.69]). Women (1.43 [1.04–1.97]) and patients who reported access to compatible electronic devices (41.05 [14.88–113.20]) and reliable internet connection (20.94 [8.34–52.60]) were more likely to be interested in telemedicine appointments. Respondents also indicated preference for a “hands on” examination over telemedicine appointments. ConclusionNearly 1 in 2 patients evaluated in a tertiary care head and neck surgical oncology clinic expressed reticence regarding telemedicine for clinical visits. Limited access to technology platforms and unreliable internet remain key concerns for these patients. Understanding the needs and attitudes of specific patient populations may be important for organizations pivoting to telemedicine platforms to ensure equity in healthcare access. Level of evidenceRetrospective analysis of prospectively collected cross-sectional survey.

Understanding breast cancer patient pathways and their impact on survival in Mexico

BackgroundUnderstanding patient pathways from discovery of breast symptoms to treatment start can aid in identifying ways to improve access to timely cancer care. This study aimed to describe the patient pathways experienced by uninsured women from detection to treatment initiation for breast cancer in Mexico City and estimate the potential impact of earlier treatment on patient survival. MethodsWe used process mining, a data analytics technique, to create maps of the patient pathways. We then compared the waiting times and pathways between patients who initially consulted a private service versus those who sought care at a public health service. Finally, we conducted scenario modelling to estimate the impact of early diagnosis and treatment on patient survival. ResultsOur study revealed a common pathway followed by breast cancer patients treated at the two largest public cancer centres in Mexico City. However, patients who initially sought care in private clinics experienced shorter mean wait times for their first medical consultation (66 vs 88 days), and diagnostic confirmation of cancer (57 vs 71 days) compared to those who initially utilized public clinics. Our scenario modelling indicated that improving early diagnosis to achieve at least 60% of patients starting treatment at early stages could increase mean patient survival by up to two years. ConclusionOur study highlights the potential of process mining to inform healthcare policy for improvement of breast cancer care in Mexico. Also, our findings indicate that reducing diagnostic and treatment intervals for breast cancer patients could result in substantially better patient outcomes. Policy summaryThis study revealed significant differences in time intervals along the pathways of women with breast cancer according to the type of health service first consulted by the patients: whether public primary care clinics or private doctors. Policies directed to reduce these inequities in access to timely cancer care are desperately needed to reduce socioeconomic disparities in breast cancer survival.

Rethinking urban park accessibility in the context of demographic change: A population structure perspective

Rapid demographic change has reshaped the demand for and use of urban parks, profoundly affecting park accessibility inequities. In response to the need for park equity planning under demographic change, we have rethought the gaps in existing park accessibility research. In this study, we revisited and modified the two-step floating catchment area (2SFCA) method, re-naming this method as the floatable supply and demand improved 2SFCA (FSD-2SFCA) method. The FSD-2SFCA method considers gaps in environmental preferences and travel abilities among population subgroups to better meet the needs of urban park planning based on demographic changes. Overall, the FSD-2SFCA method is robust, sensitive, flexible, and scalable. The method measured park accessibility in Higashiosaka City under existing and projected population dynamics (2020–2060). The results showed that spatial differences and inequalities in park accessibility exist in Higashiosaka City and that park accessibility inequities among age groups showed different trends as the population changed. In addition, park accessibility is generally the lowest and most inequitable for older adults. Our study highlights that in addressing demographic change, policymakers must consider present equitable distribution of parks and future park accessibility based on population projections to ensure equity-oriented, sustainable urban park planning.

Social impact: Trusting open science for future pandemic resilience

In response to the pressing need to improve epidemic preparedness, this paper presents the development and application of EPISOS, a project designed to improve the timeliness, completeness, and accessibility of epidemiological data. Through EPISOS, we have created a dynamic, cross-sectoral collaborative framework that supports the detection, monitoring, and risk assessment of emerging and re-emerging infectious diseases across Europe. This initiative not only addresses the challenges of standardizing data quality and resource availability, but also promotes equity in data access and use. The paper critically analyzes the difficulties encountered in these areas and outlines effective strategies for leveraging open science to strengthen public health responses. Integrating real-world examples, we illustrate the practical impact and potential of EPISOS in promoting scientific collaboration and transparency during health crises.

Self-Care Practices and Health-Seeking Behaviors Among Older Adults in Urban Indian Slums: A Mixed Methods Study.

Background Effective self-care is crucial for maintaining health among older adults in resource-constrained communities. This study examined self-care practices, health-seeking behaviors, and associated factors among older adults in urban slums in India. Materials and methods A mixed methods study was conducted among 432 adults aged ≥65 years. Participants were selected through multistage random sampling from five slum areas. Self-care practices, health-seeking behaviors, demographic information, chronic conditions, self-efficacy, and health literacy were assessed through interviews. The qualitative data was explored through in-depth interviews with 30 participants. Results Inadequate health literacy (194, 45%) and low self-efficacy (162, 37.5%) were common. While 324 (75%) had an adequate diet and 378 (87.5%) took medications properly, only 86 (20%) monitored diabetes complications. Only 194 (45%) of the patients underwent recommended cancer screening, and 324 (75%) of the patients saw doctors ≥twice a year. Age, sex, education, income, comorbidities, self-efficacy, and health literacy had significant associations. Alongside facilitators such as social support, barriers such as limited healthcare access and suboptimal prevention orientation emerged. Conclusion Suboptimal prevention orientation and overreliance on secondary care instead of self-care among elderly people are problematic given the limited use of geriatric services. Grassroots health workers can improve health literacy and self-efficacy through home visits to enable self-care. Healthcare access inequities for vulnerable groups merit policy attention.

Access to Ontario Midwifery Care by Neighbourhood-Level Material Deprivation Quintile, 2006–2017: A Retrospective Cohort Study

Objective: To describe access to Ontario midwifery care based on socio-economic status.Design: Two retrospective cohort studies.Setting: Ontario, Canada.Participants: (1) All Ontario midwifery billable courses of care discharged between April 1, 2006, and March 31, 2017 (N = 187,009), and (2) all Ontario residents who gave birth (≥ 20 weeks) in Ontario between April 1, 2012, and March 31, 2017 (N = 699,843). Data Sources: The Ontario Midwifery Program Legacy Database and the Better Outcomes Registry & Network’s Ontario perinatal registry.Measurements and Findings: We used residential postal codes to assign socio-economic status quintiles, using the Ontario Marginalization Index’s material deprivation measure. Between 2006 and 2017, the proportion of midwifery clients in the two least-marginalized quintiles was consistently greater than the proportion of midwifery clients in the two most-marginalized quintiles. Between 2012 and 2017, physicians cared for a larger proportion of people in the most-marginalized quintile than midwives, while midwives cared for a larger proportion of people in the least-marginalized quintile. Key Conclusions: People of low socio-economic status in Ontario are less likely to receive midwifery care than people of high socio-economic status. There was little change in this pattern over an 11-year period from 2006 to 2017.Implications: Efforts to reduce inequities in access to midwifery care should be prioritized and will require a multi-pronged approach that is supported by practicing midwives, government, midwifery stakeholder organizations, and other health care professionals. This article has been peer reviewed.

Universal Tobacco Screening and Opt-Out Treatment Referral Strategy Among Patients Diagnosed With Cancer by Race and Ethnicity

This quality improvement study examines whether a universal screening and opt-out referral model could promote racial and ethnic equity in access and use of tobacco treatment among patients with cancer.

Health insurance and subjective well-being: evidence from integrating medical insurance across urban and rural areas in China.

Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.

Understanding oral cancer disparities in India: Exploring socioeconomic and demographic factors impacting access to care and outcomes

The high prevalence rates, inequalities in treatment outcomes and access to care and other factors make oral cancer a major public health concern in India. The diverse aspects of oral cancer disparities in India are examined in this article, with a particular emphasis on the socioeconomic and demographic variables that affect outcomes and access to care. Disparities still exist even with improvements in treatment modalities. These are caused by low socioeconomic position, low health literacy, cultural customs, and gender variations in risk behaviors. A comprehensive strategy that includes investments in healthcare infrastructure, health education programs, and tobacco control measures is needed to reduce the disparities in oral cancer. India may strive toward providing equal access to oral cancer care for all its population by eliminating systemic injustices and encouraging preventative measures.

Water, sanitation, and hygiene access among people who inject drugs in Tijuana and San Diego in 2020–2021: a cross-sectional study

BackgroundWater, sanitation, and hygiene (WASH) access is critical to public health and human dignity. People who inject drugs (PWID) experience stigma and structural violence that may limit WASH access. Few studies have assessed WASH access, insecurity, and inequities among PWID. We describe WASH access, social and geographic inequalities, and factors associated with WASH insecurity among PWID in the Tijuana-San Diego metropolitan area.MethodsIn this cross-sectional binational study, we interviewed PWID (age 18+) in 2020–2021 about WASH access and insecurity. City of residence (Tijuana/San Diego) and housing status were considered as independent variables to describe key WASH access outcomes and to assess as factors associated with WASH insecurity outcomes. Measures of association between outcomes and independent variables were assessed using log modified-Poisson regression models adjusting for covariates.ResultsOf 586 PWID (202 Tijuana; 384 San Diego), 89% reported basic access to drinking water, 38% had basic hand hygiene, 28% basic sanitation, and 46% access to bathing, and 38% reported recent open defecation. Participants residing in Tijuana reported significantly higher insecurity in accessing basic drinking water (aRR: 1.68, 95%CI: 1.02–2.76), basic hygiene (aRR: 1.45, 95%CI: 1.28–1.64), and bathing (aRR: 1.21, 95%CI: 1.06–1.39) than those living in San Diego. Participants experiencing unsheltered homelessness experienced significantly higher insecurity in accessing basic drinking water (aRR: 2.03, 95%CI: 1.07–3.86), basic sanitation (aRR: 1.68, 95%CI: 1.48, 1.92), bathing (aRR: 1.84, 95%CI: 1.52–2.22), and improved water sources for cleaning wounds (aRR: 3.12, 95%CI: 1.55–6.29) and for preparing drugs (aRR: 2.58, 95%CI: 1.36–4.89) than participants living in permanent housing.ConclusionWASH access among PWID in the Tijuana-San Diego metropolitan area was low by international standards and lower than the national averages in both countries. Homelessness was significantly associated with WASH insecurity in this population. Concentrated efforts are needed to guarantee continuously available WASH services for PWID—especially those who are unsheltered.

The Getting It right First Time (GIRFT) programme in urology; rationale and methodology.

The Getting It Right First Time (GIRFT) programme is a quality improvement initiative covering the National Health Service in England. The programme aims to standardise clinical practices and improve patient and system level outcomes by utilising data-driven insights and clinically-led recommendations. There are GIRFT workstreams for every medical and surgical specialty, including urology. Defining features of the GIRFT methodology are that it is clinically led by experienced clinicians, data-driven, and specialty specific. Each specialty workstream conducts deep-dive visits to every hospital, analysing performance data and engaging with clinicians and management to identify and share improvement priorities. For urology, GIRFT has completed deep-dive visits and published reports outlining priority areas for development. Reports include recommendations pertaining to streamlining care pathways, reducing the acuity of care environments, enhancing emergency services, optimising utilisation of outpatient services, and workforce training and utilisation. The GIRFT academy provides guides for implementing best practices specific to priority areas of care. These include important disease pathways, and GIRFT-advocated innovations such as urology investigation units and urology area networks. GIRFT offers clinical transformation, cost reduction, equity in access to care, and leaner models of care that are often more environmentally sustainable. Evaluation efforts of the programme have focussed on assessing the adoption of GIRFT recommendations, understanding barriers to change, and modelling the climate impact of advocated practices.

Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya.

Kenya aims to achieve universal health coverage (UHC) by 2030 and has selected the National Health Insurance Fund (NHIF) as the 'vehicle' to drive the UHC agenda. While there is some progress in moving the country towards UHC, the availability and accessibility to NHIF-contracted facilities may be a barrier to equitable access to care. We estimated the spatial access to NHIF-contracted facilities in Kenya to provide information to advance the UHC agenda in Kenya. We merged NHIF-contracted facility data to the geocoded inventory of health facilities in Kenya to assign facility geospatial locations. We combined this database with covariates data including road network, elevation, land use, and travel barriers. We estimated the proportion of the population living within 60- and 120-minute travel time to an NHIF-contracted facility at a 1-x1-kilometer spatial resolution nationally and at county levels using the WHO AccessMod tool. We included a total of 3,858 NHIF-contracted facilities. Nationally, 81.4% and 89.6% of the population lived within 60- and 120-minute travel time to an NHIF-contracted facility respectively. At the county level, the proportion of the population living within 1-hour of travel time to an NHIF-contracted facility ranged from as low as 28.1% in Wajir county to 100% in Nyamira and Kisii counties. Overall, only four counties (Kiambu, Kisii, Nairobi and Nyamira) had met the target of having 100% of their population living within 1-hour (60min) travel time to an NHIF-contracted facility. On average, it takes 209, 210 and 216min to travel to an NHIF-contracted facility, outpatient and inpatient facilities respectively. At the county level, travel time to an NHIF-contracted facility ranged from 10min in Vihiga County to 333min in Garissa. Our study offers evidence of the spatial access estimates to NHIF-contracted facilities in Kenya that can inform contracting decisions by the social health insurer, especially focussing on marginalised counties where more facilities need to be contracted. Besides, this evidence will be crucial as the country gears towards accelerating progress towards achieving UHC using social health insurance as the strategy to drive the UHC agenda in Kenya.

Equity in Access to Nutrition through ICDS

With the recognition of the problem of child malnutrition in India, the government provides supplementary nutrition under the flagship scheme of Integrated Child Development Services. The scheme has a specific focus on children from geographically and socio-economically disadvantaged groups. In the recent past, although several studies have looked into the access of children to supplementary nutrition services, the effectiveness of the services on children’s nutrition status through the lens of equity has however not drawn adequate attention. This article assesses the nutritional status of children across social groups based on the standard of ‘Nutritive Value of Indian Food’. Data collected from a sample of 286 children across social groups registered under the ICDS scheme covering ten villages in two rural districts of one state; reveals that although the supplementary nutrition meets the protein intake as per the Recommended Dietary Allowances norm, deficiencies are observed in the intakes of nutrients like calorie, calcium and iron. There are notable differentials among children across social groups in the intake of nutrients. The article calls for monitoring of adequacy of supplementary nutrition services for children from disadvantaged groups, and raising nutritional awareness among caregivers.

Considering the importance of transport to the wellbeing of Māori social housing residents

BackgroundIndigenous Māori conceptualisations of home extend beyond the house and encompass the ways in which people move in and around their environments. This movement is enabled by appropriate and accessible transport systems. For Māori living in social housing, who may already be disconnected from their whānau (family group, extended family), friends and places of belonging, access to the wider urban environment is essential for supporting health and wellbeing. Despite literature depicting Māori inequities in both transport access and in transport-related health outcomes such as access to a general practitioner, there is little research that explores transport as an enabler of wellbeing for Māori living in social housing. This is the gap that this research fills. MethodsThis qualitative research took a Kaupapa Māori approach and privileged Indigenous Māori worldviews and concepts throughout. Interviews were conducted with twelve Māori residents living in social housing complexes in Christchurch New Zealand. Interviews explored how Māori experienced their housing complex and the travel they did between their complex and the wider urban environment. Interviews were transcribed verbatim, coded and analysed by the lead Māori researcher. ResultsResults describe how residents use different forms of transport to access the environment around their social housing complexes. Despite utilising a wide range of transport modes, participants discussed the barriers they face when using both private and public forms of transport. The research also looks at how Māori living in social housing perceive novel transport technologies and poses questions surrounding the suitability of these schemes for reducing transport inequities. ConclusionsThese localised experiences provide insight into the role transport plays in creating a home and in establishing and maintaining social connections for Māori living in social housing. In doing so, the research explains the link between transport access and Indigenous wellbeing while also exploring some of the concerns those living in social housing have surrounding their inclusion in transport solutions. Findings reinforce the notion that successful transport systems for Indigenous populations come from a place of co-design where Indigenous peoples are equal partners in decision-making.

101 The Burden of Burns: An Analysis of Public Health Measures

Abstract Introduction Accurate analysis of injuries and illnesses is paramount when allocating resources for education, prevention, recovery, and research. Inconsistencies in public health reports and increased lobbying/marketing by medical nonprofits has obscured the perception of burn injury (BI) leading to inequities in healthcare access and funding of reconstruction and research. A primary example of these developments is the frequently referenced and inaccurate BI statistics. Our study aims to compare national references reporting the incidence of BI and the related sequela in the U.S. Methods The American Burn Association Burn (ABA) Injury Summary Report (BISR), ABA Fact Sheet, Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting (WISQARS) database, the CDC National Center for Health Statistics’ National Hospital Ambulatory Medical Care Survey (NHAMCS), and the commercially available claims databases were queried for 2020 burn admissions and emergency department (ED) visits. Non-U.S. reports, claims, or analyses were excluded from our review. The costs of BI were reported in U.S. dollars where available. Claims analyses were conducted using ICD-10 BI codes coupled with burn DRG for admission, and CPT for surgical intervention from a commercially available database incorporating managed care, Medicare, and Medicaid payors. Results The ABA Fact Sheet reported 486,000 BI annually. The 2021 ABA BISR data represented burn admissions at approximately 100 burn centers (BC) excluding non-BC, ED, and BC not participating in BCQP. CDC’s WISQARS database reported 3,529 burn-related deaths resulting in 45,135 years of potential years of life lost, 287,926 non-fatal BI from fire/flame and contact with 76.1% of patients treated in ED only and total costs of $42.4B. Mechanisms such as scald, chemical, electrical, radiation, and inhalation injury were not included. The CDC NHAMCS reported 359,000 BI presenting to ED (23% increase from CDC WISQARS). Our analysis from claims databases demonstrated over 698,555 BI as the primary code likely underreporting self-pay/uninsured, military facilities, and endowment or community-based hospitals not submitting claims data. Conclusions Our study demonstrates a large variability in the incidence of BI. Given the increased population noted in the U.S. 2020 census, the true number of BI is likely closer to the claims database suggesting a substantial misunderstanding in the burden of burns. We additionally noted no ICD-10 codes to characterize the sequela of BI limiting our assessment of post-acute burn care challenges. Future efforts to improve CDC reporting policies and new ICD-10 codes capturing BI sequela are essential to improve advocacy and understanding of our patients and their healthcare needs. Applicability of Research to Practice This abstract will help clinicians, patients, and investigators better advocate for population health research in burn injury.

Decentralised clinical trials in rural Australia: Opportunities and challenges

AbstractAimsTo present opportunities and a model to redress the under‐representation of rural communities and people in Australian clinical trials.ContextClinical trials are essential for building and understanding the health evidence base. The lack of representation of rural people in clinical trials is evident in other countries. Examining the Australian New Zealand Clinical Trial Registry (ANZCTR) suggests this is also the case in Australia.ApproachWe propose an approach that empowers rurally based academics and clinicians to co‐design clinical trials and increase rural Australians' participation in clinical trials to address this inequality of access. A case study of a decentralised, co‐designed clinical trial is presented to support this approach.ConclusionDecentralising clinical trials could improve access to clinical trials, strengthen the social capital of rural communities and help address the health inequalities that exist between rural and metropolitan communities.

Does health insurance status influence healthcare-seeking behavior in rural communities? evidence from rural Ghana

IntroductionNational health insurance programs are considered important mechanisms for ensuring equity in access to and utilization of healthcare services by removing financial barriers associated with seeking treatment in healthcare facilities. Although studies on health insurance schemes in many low-and-middle-income countries (LMICs) have demonstrated a significant relationship between health insurance status and healthcare-seeking behavior, data on the influence of this health financing policy on the decision to seek formal healthcare among rural inhabitants remains limited. Underpinned by the Andersen-Newman behavioral model of healthcare use, this study examined the influence of health insurance status on healthcare-seeking behavior among rural dwellers in Ghana. MethodsA community-based cross-sectional study was conducted among 460 rural residents in Ghana from 8th September to 5th December 2022. Chi-square tests were used to study the significance level and association between healthcare-seeking behavior and selected independent variables. A multiple logistic regression model was fitted to test the association between health insurance status and healthcare-seeking behavior, introducing other selected explanatory variables as controls. ResultsThe mean age of the respondents was 29.6 ± 6.8 years. A little above half (53.1 %) disclosed having insurance, whereas 46.1 % stated they were without coverage. Regarding healthcare-seeking behavior, the most commonly chosen treatment source was traditional healers (37.2 %), followed by the public healthcare system (28.3 %) and self-treatment (18.2 %). The private healthcare system was the least preferred, with only 16.3 % opting for it. While the bivariate analysis demonstrated a significant relationship between health insurance status and healthcare-seeking behavior (p-0.001), the logistic regression model results showed that health insurance status was not an independent predictor of healthcare-seeking behavior (p = 0.069). ConclusionIt could, therefore, not be concluded that the respondents with health insurance coverage were more likely than the uninsured to use formal healthcare providers as their most frequent source of treatment during illness. This study provides vital information for policymakers aiming at increasing access to and utilization of facility-based formal care in rural and remote settings.

The Socio-Spatial Distribution and Equity of Access to Urban Parks: A Case Study of Bengaluru, India

The Socio-Spatial Distribution and Equity of Access to Urban Parks: A Case Study of Bengaluru, India

Inequity in access to digital public primary healthcare in Sweden: a cross-sectional study of the effects of urbanicity and socioeconomic status on utilization.

Social and geographical inequity in access to primary healthcare is an ongoing concern in Sweden. Digital care can potentially decrease geographical inequity. This study aimed to evaluate how urbanicity affects the utilization of a public digital primary healthcare service - PHC Online. We performed an ecological cross-sectional study of 4,482 PHC Online visits grouped by 83 public primary healthcare centers. Multiple linear regression analysis was performed with PHC Online visits per 1,000 registered patients as the dependent variable and urbanicity (municipalities grouped by number of inhabitants), socioeconomic status (Care Need Index), and morbidity (Adjusted Clinical Groups) per primary healthcare center as independent variables. Utilization of PHC Online was more common among those of a younger age (median 32 years) and among women (65%). Urbanicity did not affect utilization. Lower socioeconomic status and higher morbidity had negative effects on utilization (B -3.289, p = 0.001, B -7.728, p = 0.045). Geographical differences based on urbanicity do not seem to affect the utilization of PHC Online. Further studies are needed to clarify a possible association to geographical barriers in access to primary healthcare, specifically accounting for factors associated with urbanicity and distance to physical clinics, and how age and sex affect such an association. Lower utilization of PHC Online in low socioeconomic status and high morbidity populations raises questions on the effect of digital primary care on equitable access to primary healthcare.