Choice Of Facility Research Articles

Adverse birth outcomes among women with 'low-risk' pregnancies in India: findings from the Fifth National Family Health Survey, 2019-21.

Despite substantial progress in improving maternal and newborn health, India continues to experience high rates of newborn mortality and stillbirths. One reason may be that many births happen in health facilities that lack advanced services-such as Caesarean section, blood transfusion, or newborn intensive care. Stratification based on pregnancy risk factors is used to guide 'high-risk' women to advanced facilities. To assess the utility of risk stratification for guiding the choice of facility, we estimated the frequency of adverse newborn outcomes among women classified as 'low risk' in India. We used the 2019-21 Fifth National Family Health Survey (NFHS-5)-India's Demographic and Health Survey-which includes modules administered to women aged 15-49 years. In addition to pregnancy history and outcomes, the survey collected a range of risk factors, including biomarkers. We used national obstetric risk guidelines to classify women as 'high risk' versus 'low risk' and assessed the frequency of stillbirths, newborn deaths, and unplanned Caesarean sections for the respondent's last pregnancy lasting 7 or more months in the past five years. We calculated the proportion of deliveries occurring at non-hospital facilities in all the Indian states. Using data from nearly 176,699 recent pregnancies, we found that 46.6% of India's newborn deaths and 56.3% of stillbirths were among women who were 'low risk' according to national guidelines. Women classified as 'low risk' had a Caesarean section rate of 8.4% (95% CI 8.1-8.7%), marginally lower than the national average of 10.0% (95% CI 9.8-10.3%). In India as a whole, 32.0% (95% CI 31.5-32.5%) of deliveries occurred in facilities that were likely to lack advanced services. There was substantial variation across the country, with less than 5% non-hospital public facility deliveries in Punjab, Kerala, and Delhi compared to more than 40% in Odisha, Madhya Pradesh, and Rajasthan. Newborn mortality tended to be lower in states with highest hospital delivery rates. Individual risk stratification based on factors identified in pregnancy fails to accurately predict which women will have delivery complications and experience stillbirth and newborn death in India. Thus a determination of 'low risk' should not be used to guide women to health facilities lacking key life saving services, including Caesarean section, blood transfusion, and advanced newborn resuscitation and care. Bill and Melinda Gates Foundation and the World Bank. The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the Gates Foundation or of the World Bank, its Executive Directors, or the countries they represent.

Assessment of the typology of Housing for private university staff in South West, Nigeria

This study aims to ascertain the choice of the staff’s accommodation in southwest private universities in Nigeria; to ensure the functionality and optimal performance of facilities in their choice of housing. In achieving the aim, this study purposely selects 5 private universities to represent the entire private universities in Southwest, Nigeria. 200 questionnaires were distributed randomly among the staff of the selected institution to get the fact about their choice of accommodation and facilities. Descriptive and Statistical analyses of data were used to discuss findings from the collected data. Findings show, that most of the staff prefer one room self-contain or one bedroom self-contain apartment with facilities like Air Conditioner, Wifi, Furniture, Television with DSTV, Library/Study Area and Refrigerator. To increase and achieve optimal satisfaction in apartment and facility to serving staff, It is therefore recommended that there is a need to map out an effective internal evaluation system to build a feedback mechanism by which the state of apartment and facilities performance can be monitored periodically to meet the staffs housing choice. Keywords: Housing, Choice, Staff, Private University, South West

Effects of Different Exercise Programs on Symptoms, Sleep, and Quality of Life in Patients with Primary Restless Legs Syndrome.

Restless legs syndrome (RLS) is a sensorimotor disorder that can have a significant detrimental impact on the quality of life and sleep. Our aim was to examine the effects of aerobic exercise and stretching exercise programs on symptom severity, sleep, and quality of life in patients with primary RLS. A total of 18 patients between the ages of 22 and 61 were randomly divided into 3 groups as aerobic exercise, stretching exercises, and control. All exercise programs were applied 3 times a week for 8 weeks. Evaluations were performed before and after treatment. Symptom severity of the patients was evaluated by the International Restless Legs Syndrome Study Group Rating Scale, sleep was evaluated with the Pittsburgh Sleep Quality Index and actigraphy, and quality of life was evaluated with the John Hopkins Restless Legs Syndrome Quality of Life Questionnaire. Recovery status of the patients was determined using the post treatment global change scale. Aerobic exercise and the stretching exercise program were found to be effective in decreasing RLS symptoms (P = 0.025, P = 0.034) and improving subjective sleep quality (P = 0.034, P = 0.025), overall sleep quality (P < 0.001, P = 0.034), and quality of life (P = 0.009, P = 0016). Aerobic exercises were found to be more effective in reducing wake after sleep onset of sleep (P = 0.048), whereas stretching exercises reduced sleep disorders (P = 0.025). Both exercise approaches have been identified as highly effective approaches in patients with RLS. The treatment can be planned according to the choice of the available facilities, patient and clinician preference, and the advantages of the 2 exercise approaches.

Empirical Analysis of Preferences of Older Adults for Care Facilities in Japan: Focusing on Household Structure and Economic Status.

Japan is advancing into a super-aged society at an unprecedented speed, and the proportion of the elderly population will continue to rise. The number of older adults needing nursing care will also increase with the aging population. We used a cross-sectional dataset of older Japanese adults to examine their future preferences for care facilities and their relationship with individual characteristics, household structure, and economic status. We further focused on a subgroup of those who lived alone and were experiencing poverty and examined their care needs through their choice of care facilities. We found the following results from multinomial logit and probit regressions. First, compared with living alone, older adults who live with their spouses or other members prefer to live in their own houses. Second, older adults experiencing poverty preferred to choose facilities geared towards low-income groups, while wealthy older adults preferred to choose fee-based nursing homes/nursing homes with diverse services and high costs. Third, single older adults in poverty were less likely to choose to live in facilities. Covariates such as sex, age, and health status also mattered in their choices. Therefore, tailoring the formal care services to the preferences and actual needs of older adults is imperative.

Sanitation and Hygiene Practices in Northern Ghana: An Analysis of Household Health Risks

This study assessed household health risks in relation to sanitation and hygiene practices. A convergent parallel mixed method design, involving a survey of 200 household heads and two semi-structured interviews, was employed. The forward linear regression method was used to determine how sanitation and hygiene practices influence household health risks. From the results, age was the most considered criterion for using a homestead toilet facility. Income made the most significant contribution to change in the choice of toilet facility with a Beta Weight of 0.313 at a statistically significant level of p&lt;0.00. Income was again identified to be the most statistically significant determining factor for access to sanitation and hygiene materials with 0.389 at a significant alpha level of p&lt;0.00. The identified factors that define sanitation and hygiene practices cut across gender division of labour, age, occupation, housing type and residential location. Owing to the range of demographic, social and economic factors influencing the adoption of proper sanitation and hygiene practices, it is recommended that sanitation and hygiene improvement interventions should inculcate socio-demographic and economic concepts to reduce household health risks.

Factors affecting Nepalese rural dwellers’ choice of first-contact health facility: a cross-sectional survey

Background Despite significant progress in Nepal’s health indicators over the past three decades, regional disparities in public health centre (PHC) provision and accessibility remain severe. It has been reported that rural dwellers prefer and place more trust in outreach centres (ORCs) run by the Dhulikhel Hospital. However, the reasons behind this remain unclear. We aimed to examine the determinants of Nepalese rural dwellers’ choice of first-contact health facility. Methods This was a cross-sectional survey among 1,098 adult rural dwellers in Nepal. The study sample was first divided into PHC and ORC groups, and intergroup differences were tested using Pearson chi-square test and independent sample t-test. Then, binary logistic regression was performed to analyse first-contact health facility decision-making. Results Sex, education level, importance of health care satisfaction, importance of free health care, diagnosis of hypertension, diagnosis of diabetes, insurance coverage, savings, community-level cooperation, and distance to the health facility were significant factors affecting the choice of the first-contact health facility. Most significantly, people who were unconcerned about receiving free health care were 19.417 times more likely to use ORCs. Additionally, it was observed that rural dwellers perceived ORCs as providing higher quality health care. Conclusions The government must promote cooperation between PHCs and ORCs, as it is essential to understand consumer demand, supply-side issues, and institutional aspects of health care in rural areas to achieve universal access to health care.

Choice of a family planning outlet in urban areas: The role of distance and quality of services in Kenya and Uganda.

Quality of care and physical access to health facilities affect facility choice for family planning (FP). These factors may disproportionately impact young contraceptive users. Understanding which components of service quality drive facility choice among contraceptive users of all ages can inform strategies to strengthen FP programming for all potential users of FP. This study uses data from Population Services International's Consumer's Market for Family Planning (CM4FP) project, to examine drivers of facility choice among female FP users. The data collected from female contraceptive users, the outlet where they obtained their contraceptive method, and the complete set of alternative outlets in select urban areas of Kenya and Uganda were used. We use a mixed logit model, with inverse probability weights to correct for selection into categories of nonuse and missing facility data. We consider results separately for youth (18-24) and women aged 25-49 in both countries. We find that in both countries and across age groups, users were willing to travel further to public outlets and to outlets offering more methods. Other outlet attributes, including signage, pharmacy, stockouts, and provider training, were important to women in certain age groups or country. These results shed light on what components of service quality drive outlet choice among young and older users and can inform strategies to strengthen FP programming for all potential users of FP in urban settings.

Medicare advantage and dialysis facility choice.

To compare the characteristics of dialysis facilities used by traditional Medicare (TM) and Medicare advantage (MA) enrollees with end-stage kidney disease (ESKD). We used 20% TM claims and 100% MA encounter data from 2018 and publicly available data from the Centers for Medicare and Medicaid Services. We compared the characteristics of the dialysis facilities treating TM and MA patients in the same ZIP code, adjusting for patient characteristics. The outcome variables were facility ownership, distance to the facility, and several measures of facility quality. We identified point prevalent dialysis patients as of July 15, 2018. Compared to TM patients in the same ZIP code, MA patients were 1.84 percentage points more likely to be treated at facilities owned by the largest two dialysis organizations and 1.85 percentage points less likely to be treated at an independently owned facility. MA patients went to further and lower quality facilities than TM patients in the same ZIP code. However, these differences in facility quality were modest. For example, while the mean dialysis facility mortality rate was 21.85, the difference in mortality rates at facilities treating MA and TM patients in the same ZIP code was 0.67 deaths per 100 patient-years. Similarly, MA patients went to facilities that were, on average, 0.15 miles further than TM patients in the same ZIP code. MA enrollees with ESKD were more likely than TM enrollees in the same ZIP code to use the dialysis facilities owned by the two largest chains, travel further for care, and receive care at lower quality facilities. While the magnitude of differences in facility distance and quality was modest, the direction of these results underscores the importance of monitoring dialysis network adequacy as ESKD MA enrollment continues to grow.

RESORT PANTAI BATAKAN BARU

Geographically, Indonesia is an agricultural country with a very wide area and many have abundant natural resources, one of which is the beach which is often used by the government as a tourism industry sector. When viewed from the flow of tourist visitor growth in South Kalimantan, it has surged every year. In order for the development of the tourism sector of Batakan Baru Beach to increase, facilities and accommodations are needed that can accommodate all tourist activities. The right choice of accommodation facilities is a resort with a coast to coast glamping resort concept with a biomorphic architecture analogy design method. The choice of this concept is able to solve design problems that are disaster responsive and environmentally friendly and able to shape the behavior of visitors to participate in protecting the environment.

Service expansion for chained business facilities under congestion and market competition

We study a service expansion problem for chained business facilities under endogenic facility congestion and exogenous market competition. More specifically, we consider a company that operates a chain of facilities and plans to expand service capacities with the objective of maximizing its profit, accounting for revenue and expansion costs. To estimate revenue, the company needs to anticipate customer behaviors. Due to the co-existence of competition and congestion, customer behaviors are explained as a two-stage process. In the first stage, customers make “channel” choices, i.e., they decide whether to seek services from the company. Such a choice reflects the market competition and is predicted by a discrete choice model. Subsequently, customers who select the company will choose one facility to patronize. Owing to congestion, the facility choice will induce “user equilibrium”, which in return affects the outcome of market competition. To facilitate the company’s decision-making in this complex business environment, we develop a generic modeling framework. Unfortunately, the proposed model is nonconvex. To solve it, we first design an approximate mixed-integer linear programming approach subject to adjustable approximation errors. We then propose a surrogate optimization framework for large-scale instances, which explores the hidden bilevel structure of the model and leverages a “learning-to-optimize” problem and a customer behavior estimation subroutine. Using extensive computational experiments, we demonstrate the effectiveness of the proposed approaches. Finally, we conduct sensitivity analysis and draw practical implications.

Characteristic Factors of Health Micro Insurance Against Considerations in Selection of Health Service Facilities

Indonesia is still faced with a series of health problems. One of the causes of health problems is the expensive cost of treatment. An alternative that people can choose for health financing is to have health micro-insurance aimed at lower-middle-class households. The purpose of this study was to identify factors characteristic of micro-insurance, against the consideration of choosing health service facilities. The data used were primary data obtained through a questionnaire of 220 health micro-insurance participants. This research was analyzed with a quantitative descriptive approach. The results of the analysis show that the characteristics of hospitals that are registered as good quality micro-insurance services and responsive to providing referrals to hospitals, when there are patient complaints are the main factors in considering the choice of health service facilities.

Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria

Aims: Factors that influence the personal choice of a health care facility among health care consumers vary. Currently, what influences the choice of health facilities among enrollees under the National Health Insurance Scheme (NHIS) is not known. This study aimed to as-sess what influences the choice of facilities in the NHIS of Nigeria. Methods: This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in the 11 Local Government Areas (LGAs) of Ibadan, Nigeria. A total of 432 enrollees were selected and were interviewed. A WHO-USAID semi-structured interviewer-administered questionnaire was used to obtain relevant data. Data collection was between Oc-tober and December 2019. Data were analyzed using STATA version 12.0 (α =0.05).Results: At unadjusted OR, older respondents (OR 3.24, CI = 2.52-4.18, p = &lt;0.0001), and those who had attained the tertiary level of education (OR 3.30, CI 2.57-4.23, p &lt;0.0001) were more likely to make a personal choice of health care facilities. A similar pattern was ob-served among respondents who were in the high socioeconomic group (OR 4.10, CI 3.01-5.59, p = &lt;0.0001). However, at Adjusted OR, only high socio-economic status was a predic-tor of personal choice of health care facility (OR 1.92, CI 1.21-3.05, p = 0.005). Conclusion: This study is suggestive that a need for and the ability to afford the cost of care influence the choice of health facilities. Policies that promote health literacy in the general populace will enhance the capability of individuals to make a personal choice of health facili-ties. Stakeholders should prioritize this for policy.Recommended citation: David A. Adewole, Temitope Ilori. Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria Acknowledgments: The authors wish to acknowledge study participants for permission to interview them in the course of the data collection of this study.Authors' contributions: David Adewole conceived and designed the study. Temitope Ilori did data collection and analysis. Both authors contributed equally to the manuscript write-up. The two authors also read through the manuscript draft the second time and agreed to the final manuscript. Conflict of interests: None declared.

Factors influencing choice of healthcare facilities utilisation by rural households in Ogun State, Nigeria

Abstract Understanding the choice of healthcare facility utilisation is essential to the provision of need-based healthcare services to the population. This study was carried out to estimate factors influencing the choice of healthcare facilities utilised by rural households. A multistage sampling procedure was used to select 240 rural households comprising 1440 persons. Data were collected with the use of a structured questionnaire and analysed with descriptive techniques and a multivariate probit (MVP) model. The MVP result showed that households supplement public healthcare facilities with private clinics, support traditional medical treatment with self-medication, and replace self-medication with public healthcare facilities and private clinics. Similarly, age, gender, household size, cost of drugs, distance to public healthcare facilities, travelling cost, contact with community health workers, total income, awareness of public health facilities, quality of health facilities, and terrain of health facilities influence the choice of healthcare facilities utilised. The study concluded that increased total income, contact with community health extension workers, awareness of health facilities, and perceived quality of services rendered positively influence the choice of healthcare facilities sorted after while the increase in the cost of drugs, distance to health facilities, travelling cost and difficult terrain of health facilities negatively impact the choice of healthcare facilities utilised. The study recommended that public healthcare facilities should be located within the reach of the people and equipped with essential drugs at a reduced cost. Households should also engage in activities that will increase their income so that they can use better healthcare facilities.

Examining the predictors of healthcare facility choice for outpatient care among older adults in India using Andersen’s revised healthcare utilization framework model

In India, the demand for outpatient care is substantially higher than inpatient care among older adults. Therefore, the current study examines the level, patterns, and factors associated with outpatient care use. The present research used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18). A total of 34,588 older adults (45years and above) who accessed outpatient healthcare services in one year prior to the survey were included in this study. A bivariate chi-square test was applied to present the percentage distribution of types of outpatient healthcare utilization by background characteristics and healthcare responsiveness. Multinomial logistic regression analyses were employed to explore the interplay of outpatient healthcare utilization and allied predisposing, enabling, and need factors. About 63.7% of total older adults used a private facility, followed by22.8% used a public facility, and 13.5% used other facilities. Years of schooling, household wealth status, place of residence, self-rated health, and health insurance were all found to be significant determinants of public or private facility use. In contrast, respondents' sex was found to be a significant determinant of private healthcare use only. The study finds that there was inadequate healthcare reaction to public health facilities. The current study revealed that the use of private facility for outpatient care is noticeably high in India. Older adults' educational attainments, health insurance coverage, and householdlevel economic background were found to be significant factors in healthcare choice. The current study emphasizes the need to strengthen public healthcare services for outpatient care.

Influence of Hotel Ambience and Performance of Hotels in Uganda. A Critical Literature Review

Purpose: Globally, there are over 160,000 star rated hotels with more than 14 million accommodation (rooms) available to millions of customers across low, middle and upmarket hotels. The overall objective of this study was to examine influence of hotel ambience and performance of hotels in upmarket areas.&#x0D; Methodology: The paper used a desk study review methodology where relevant empirical literature was reviewed to identify main themes and to extract knowledge gaps.&#x0D; Findings: The study concluded that upmarket hotel managers should improve and maintain consistency in service quality to enhance accommodation performance of their hotels. Upmarket hotel managers should place considerable importance on improving the levels of service reliability/trustworthiness, service reputation/credibility, and service recovery when something goes wrong, service accessibility/flexibility, service professionalism/skills and service behaviour/attitude in their daily operations. Upmarket hotel managers pay more attention to service quality delivery for better room efficiency and customer satisfaction.&#x0D; Unique Contribution to Theory, Policy and Practice: This study recommended that that the hotel regulatory authorities should improve on regulations and control of accommodation facilities to facilitate better accommodation performance of upmarket hotels. Upmarket hotel managers should consistently improve the quality of room facilities and service quality as well as support regulatory control to cause positive and significant changes in accommodation performance of upmarket hotels. The customers should use hotel star rating status as guide in comparing and making decisions on choice of accommodation facilities of upmarket hotels.

Factors that Impact Patients' Choice of Radiation Oncologist in the Era of Social Media: A Nationwide Analysis in the Largest Country from Latin America

<h3>Purpose/Objective(s)</h3> The choice of a medical facility and professionals to perform any kind of treatment was always based on the indication of doctors or patients, as well as information about clinical staff reputation. In the last five years, with the boom of social media, many health professionals have been using these tools to create a new way of attracting patients, especially in areas related to aesthetic and well-being. We aim to discover the current influence of social media on patients' choice of radiation oncologist and radiation therapy center. <h3>Materials/Methods</h3> We performed a nationwide standardized questionnaire with patients undergoing radiation therapy or with treatment completed in the last 2 years. In addition to demographic and marketing data, an importance score that ranged from not relevant (0) to very important (5) was applied to factors such as the physician's place of training, referral from other physicians, referral from relatives, popularity on social media and availability of state-of-the-art equipment. We also evaluated the importance of data such as online patient testimonials, health insurance coverage, content published on the internet, geographic distance and others in the decision-making process. A Multivariate analysis was performed, completed with multivariate regression and Cox proportional hazard model. <h3>Results</h3> A total of 2012 patients were interviewed, 52% of whom were men, mean age of 53 years, distributed proportionally in the 5 Brazilian geographic regions. The vast majority (65%) sought information before scheduling the first appointment, with 71% using the internet in general for this purpose, of which 19.7% used social media. Factors such as reputation of the place that the physician concluded radiation oncology training and others physicians and patients' recommendations had much more weight in the decision than factors such as popularity on social media, publication of scientific articles and availability of state-of-the-art equipment for treatment in the facility, according to the applied score. Among patients who select their physicians and treatment centers based on information from the internet, the most relevant factor for the decision was the presence of patient testimonials (61%) on the physician's page of any social media or website, followed by the reputation of the physician's main training site (19%) and distance from the treatment facility (5%). <h3>Conclusion</h3> A solid medical education in a center of excellence and a good relationship with the local medical community and patients remains the main ways to attract new patients to radiation oncologists in Brazil, regardless of their popularity on social media. Nonetheless, it is essential to remain present in these digital ecosystems as this is where the vast majority of patients seek to endorse information and references about health professionals in general.

General paediatrics: motives and concerns of medical students on the career pathway

Abstract Child public health is dependent on preventive care provided by primary care physicians for children and adolescents. Nevertheless, their accessibility in Czechia is exceedingly endangered by their ageing (the average increased by 1.5 years to 57.5 in eight years). This study aims to (1) identify medical students who opt for paediatric residency and explore the effect of undergraduate training on their decision, (2) detect factors that would persuade them to become practitioners, and (3) factors influencing their choice of a medical facility. The analysis builds on our survey's unique data exploring students’ views on training and occupational preferences. Students in the fourth to the sixth year of all medical faculties in Czechia were addressed in two waves (2020 and 2021) of this cross-sectional study, resulting in 2,283 complete questionnaires (response and coverage rate of 25.3%). Out of these, 306 respondents have already decided on or shortlisted paediatrics as a residency speciality, with a strong over-representation of women (85.3%). The evaluation of undergraduate paediatric training's quality (in terms of its organisation, number of students and teachers’ feedback) is mildly correlated with considering the paediatric residency (Cramer's V &amp;lt; 0.1). Fewer administrative obligations represent the most frequent factor necessary to lean towards primary care, reported by 54% of respondents preferring hospital paediatrics (or yet undecided); a financial entry bonus is less convincing (only 27% of them). To attract graduates, medical facilities need to provide favourable conditions for residency (good supervisor, employer's support in the training); financial offers might not be an adequate decoy in less-attractive areas. This survey sheds light on medical students’ views and decision-making processes, which are essential to consider in the public discussion on the future accessibility of primary care for children and adolescents. Key messages

The carbon footprint of proposed {mathrm{e}}^+{mathrm{e}}^- Higgs factories

The energy consumption of any of the {mathrm{e}}^+{mathrm{e}}^- Higgs factory projects that can credibly operate immediately after the end of LHC, namely three linear colliders (CLIC, operating at sqrt{s},=,380 GeV; and ILC and {mathrm{C}}^3, operating at sqrt{s},=,250 GeV) and two circular colliders (CEPC and FCC-ee, operating at sqrt{s},=,240 GeV), will be everything but negligible. Future Higgs boson studies may therefore have a significant environmental impact. This note proposes to include the carbon footprint for a given physics performance as a top-level gauge for the design optimisation and, eventually, the choice of the future facility. The projected footprints per Higgs boson produced, evaluated using the 2021 carbon emission of available electricity, are found to vary by a factor 100 depending on the considered Higgs factory project.

Health-seeking behaviour, referral patterns and associated factors among patients with autoimmune rheumatic diseases in Ghana: A cross-sectional mixed method study.

BackgroundChallenges exist in the diagnosis and management of autoimmune rheumatic diseases in low and middle income countries due to factors, such as poverty and under-resourced healthcare infrastructure. Furthermore, other contributory factors such as societal, cultural and religious practices influence health seeking behaviour which has a bearing on access and delivery of healthcare.ObjectivesTo examine the health seeking behaviour and referral patterns of Ghanaian patients with autoimmune rheumatic diseases and assess the associated factors that influence these.MethodA cross-sectional study using an explanatory sequential mixed method design was carried out in a Rheumatology clinic at a national referral centre. 110 participants were purposively recruited for the quantitative phase. The qualitative phase comprised 10 participants for in-depth interviews and 10 participants for a focus group discussion. Analysis using descriptive statistics, t-tests and logistic regression models were performed. Transcripts generated from the interviews and focused group discussion were analysed using thematic analysis.ResultsMedian duration from onset of symptoms until seeking help was 1 week (IQR = 12); from seeking help until obtaining a final diagnosis was 12 months (IQR = 33). Multiple factors determined the choice of first facility visited, X2 (12, N = 107) = 32.29, p = .001. Only twenty-one participants (19.6%) had knowledge of their disease prior to diagnosis. Education predicted prior knowledge [OR = 2.6 (95% CI = .66–10.12), p < .021]. Unemployed participants had increased odds of seeking help after a month compared to those who were employed [Odds ratio = 2.60 (95% CI = 1.14–5.90), p = .02]. Knowledge of autoimmune rheumatic diseases was low with multiple causative factors such as biomedical, environmental and spiritual causes determining where patients accessed care. Forty (36.4%) participants utilised complementary and alternative treatment options.ConclusionWe observed that knowledge about autoimmune rheumatic diseases among Ghanaian patients was low. Patients sought help from numerous medical facilities, traditional healers and prayer camps often contributing to a delay in diagnosis for most patients. This was influenced by individual perceptions, cultural beliefs and socioeconomic status. Active awareness and educational programmes for the public and healthcare workers are required, as well as strategic planning to integrate the biomedical and traditional care services to enable earlier presentation, accurate diagnosis and better clinical outcomes for the patients.

Distance and health facility choice: Evidence from a health micro insurance program in Punjab, Pakistan.

Health micro insurance offers a promising mechanism to protect the poor against risk and vulnerability arising from catastrophic healthcare expenditures. In light of this, we study the relationship between physical distance to hospitals and the choice of healthcare services in the context of a health micro insurance program in Punjab, Pakistan. We address three main research questions; first, how does physical distance affect choice of health facility? Second, is the burden of physical distance greater for women? Third, can the diffusion of information in social networks be a potential mechanism for reducing the burden of distance? We employ a Probit model with administrative data on hospitalisation claims made between 2014 and 2017. Our findings show that distance impedes individuals from making panel (cashless) claims and thus increases the likelihood of out-of-pocket expenditures at nearby non-panel hospitals. This adverse effect is more pronounced for women as compared to men. Dissemination of information in social networks increases the usage of panel facilities, especially by women. Hence, this can be an effective mechanism in reducing the role that distance plays in the choice of health facility.