Geographic Access Research Articles

Accessibility to prenatal care at the Street Outreach Office: nurse perceptions in northern Brazil.

to understand nurse perspectives regarding homeless pregnant women's accessibility to prenatal care. a qualitative study, with analysis based on the concept of accessibility. Semi-structured interviews were carried out with 11 nurses who work at the Street Outreach Office in northern Brazil. nurses are faced with geographic barriers and dangerous situations in border regions, recognizing that there is a context of physical, sexual and psychological violence that involves homeless pregnant women who seek care at the Street Outreach Office. Street Outreach Office nurses' work occurs in conjunction with other services in the Health Care Network. The implementation of educational measures is a powerful strategy, as is establishing links with women. the Street Outreach Office's work provides meetings with pregnant women on site in the territory, which can provide geographic and socio-organizational accessibility to prenatal care.

Geographical Accessibility to Basic Infrastructures and Services in Rural Senegal: The Case of the Niakhar Area

Geographical Accessibility to Basic Infrastructures and Services in Rural Senegal: The Case of the Niakhar Area

Regional inequalities in access to hospital birth in the state of Rio de Janeiro, Brazil: travel networks, distance, and time (2010-2019)

Difficult access to birth care services is associated with infant and neonatal mortality and maternal morbidity and mortality. In this study, data from the Brazilian Unified National Health System (SUS) were used to map the evolution of geographic accessibility to hospital birth of usual risk in the state of Rio de Janeiro, Brazil, corresponding to 418,243 admissions in 2010-2011 and 2018-2019. Travel flows, distances traveled, and intermunicipal travel time between the pregnant women's municipality and hospital location were estimated. An increase from 15.9% to 21.5% was observed in the number of pregnant women who needed to travel. The distance traveled increased from 24.6 to 26km, and the travel time from 76.4 to 96.1 minutes, with high variation between Health Regions (HR). Pregnant women living in HR Central-South traveled more frequently (37.4-48.9%), and those living in the HRs Baía da Ilha Grande and Northwest traveled the largest distances (90.9-132.1km) and took more time to get to the hospital in 2018-2019 (96-137 minutes). The identification of municipalities that received pregnant women from many other municipalities and municipalities that treated a higher number of pregnant women (hubs and attraction poles, respectively) reflected the unavailability and disparities in access to services. Regional inequalities and reduced accessibility highlight the need to adapt supply to demand and review the distribution of birth care services in the state of Rio de Janeiro. This study contributes to research and planning on access to maternal and child health services and can be used as a reference study for other states in the country.

Consequences of geographical accessibility to post-exposure treatment for rabies and snakebite in Africa: a mini review.

Rabies and snakebite envenoming are two zoonotic neglected tropical diseases (NTDs) transmitted to humans by animal bites, causing each year around 179,000 deaths and are most prevalent in Asia and Africa. Improving geographical accessibility to treatment is crucial in reducing the time from bite to treatment. This mini review aims to identify and synthesize recent studies on the consequences of distance and travel time on the victims of these diseases in African countries, in order to discuss potential joint approaches for health system strengthening targeting both diseases. A literature review was conducted separately for each disease using Pubmed, Google Scholar, and snowball searching. Eligible studies, published between 2017 and 2022, had to discuss any aspect linked to geographical accessibility to treatments for either disease in Africa. Twenty-two articles (8 on snakebite and 14 on rabies) were eligible for data extraction. No study targeted both diseases. Identified consequences of low accessibility to treatment were classified into 6 categories: (1) Delay to treatment; (2) Outcome; (3) Financial impacts; (4) Under-reporting; (5) Compliance to treatment, and (6) Visits to traditional healers. Geographical access to treatment significantly influences the burden of rabies and snakebite in Africa. In line with WHO's call for integrating approaches among NTDs, there are opportunities to model disease hotspots, assess population coverage, and optimize geographic access to care for both diseases, possibly jointly. This could enhance the management of these NTDs and contribute to achieving the global snakebite and rabies roadmaps by 2030.

Echoes of Home: Mapping Vulnerable Places for Cantonese‐Speaking Immigrants Seeking Family Doctors in the Greater Toronto Area

Family doctors serve as the initial contact for individuals seeking regular medical service like routine physical exam, diagnosis, and treatment of illness. Nonetheless, immigrant population who do not speak the official language usually prefers receiving healthcare in their own mother tongues. Past studies have focused on exploring accessibility to family doctors speaking Mandarin Chinese, which is not mutually intelligible with another major Chinese language called Cantonese. Despite the significant number of Cantonese‐speaking population in the Greater Toronto Area (GTA) and a recent wave of immigration from Hong Kong, China (hereafter “Hong Kong”) to Canada, little knowledge has been obtained regarding the geographic accessibility to Cantonese‐speaking family doctors. This study seeks to fill the knowledge gap of spatial accessibility to Cantonese‐speaking family doctors in the GTA by using the two‐step floating catchment area (2SFCA) method. By considering the vulnerability in terms of spatial accessibility and attractiveness to the new immigrants from Hong Kong, we have unveiled that more than 90% of neighbourhoods, with below‐median accessibility scores across all five thresholds yet high likelihood of attracting new Hong Kong immigrants, are clustered within four lower‐tier municipalities of Markham, Toronto, Richmond Hill, and Vaughan. This study not only sheds lights on the knowledge gap but also provides timely guidance in formulating public health policies in light of the incoming Cantonese‐speaking immigrants from Hong Kong.

Experiences and perspectives on chimeric antigen receptor (CAR) T-cell therapy among recipients, carers and referrers (RE-TELL): a qualitative study to inform CAR T-cell service design

ObjectivesRE-TELL is a qualitative study, which aims to understand patient, support person, clinician and coordinator experiences and perspectives of chimeric antigen receptor (CAR) T-cell therapy, to inform design of a...

Association between the home-to-healthcare center distance and hearing aid abandonment among older adults.

Access to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment. To assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system. 455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects. Approximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04-1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity. A higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).

Spatial clusters of potentially preventable hospitalisations and access to allied health services in South Western Sydney: a geospatial study.

ObjectiveTo explore the association between geographic access to allied health services and potentially preventable hospitalisations.MethodsThis is a retrospective observational study. Adults aged 18years or older with a potentially preventable hospitalisation for a chronic condition(s) to a public hospital in South Western Sydney Local Health District between 1 July 2016 and 30 June 2019 were identified from the Secure Analytic for Population Health and Intelligence portal at NSW Health. Locations of allied health amenities or practices in the same geographic area were identified from the 2019 National Health Service Directory. Geospatial analysis was used to identify geographic hotspots and coldspots of potentially preventable hospitalisations. Association with access to allied health services was investigated using linear models.ResultsHotspots of potentially preventable hospitalisations were significantly more disadvantaged than coldspots. Hotspots also had poorer access to allied health services than coldspots.ConclusionIn South Western Sydney, populations with higher burden of chronic disease, as measured through preventable hospitalisations, have poorer access to allied health services than populations with lesser need.

Factors linked to the late diagnosis of breast cancer and the initiation of treatment.

Breast cancer is the first cancer in women in terms of incidence and mortality. In Morocco, it is a public health problem. Its prognosis is strongly linked to the stage at which it is diagnosed. It is a pathology for which diagnosis means are highly developed today, ranging from early detection to the demonstration of infra-clinical lesions, which has markedly improved the prognosis in developed countries. This work aims to identify the factors that lead patients to consult at an advanced stage in our daily practice. It is a retrospective study carried out from January 2018 to December 2018 including 525 patients with breast cancer followed in the medical oncology department of the Mohammed VI University Hospital in Marrakech. The average age was 54. The average time for consultation was 10.3 months. 63% of patients were from rural areas. Delayed diagnosis affected women above 35 years of age (80%). The most common method of detection was self-examination in 74% of cases. Inflammation (2.66%), ulceration (1.14%), signs of metastases (17.14%), and isolated breast nodes (79.4%) were other reasons for consultation. 82.2% of patients were locally advanced at the time of diagnosis. The time for treatment in our study was 3.7 weeks. In our practice, it is the conjunction of ignorance, poverty, socio-cultural habits, and difficult geographical access that are the essential factors in the late diagnosis of breast cancer.

Study protocol for the development of a real-time interface showing the availability of breast and cervical cancer services in Ghana.

The 5-year survival rates for breast and cervical cancers in Ghana are low in comparison to rates in developed countries. This striking disparity is attributed to numerous factors, including limited access and navigability to appropriate services. A one-time cross-sectional, hospital-based survey was performed by the University of Utah in collaboration with Ghana Health Services (GHS) and Health Facilities Regulatory Agency (HeFRA) from November, 2020 to October, 2021 so as to determine existing hospital-based breast and cervical cancer care services capacity and their geographic availability nationwide. This related information remains dynamic in nature and time. The current project employs a public-academic implementation science and research configuration to explore and develop a real-time interface (RTIF) showing the availability of breast and cervical cancer care services at hospital facilities in-country so as to anchor up-to-date data products for the government, private-sector, and patient-centric consumption. Multiple methods will be employed to achieve the study objectives between December 2023 to November 2024. The first three objectives shall focus on contextual, needs, and feasibility assessments guided by the domains and constructs within the updated Consolidated Framework for Implementation Research (CFIR) during coding and thematic qualitative analysis. Using purposive sampling, breast and cervical cancer care service stakeholders shall be identified for individual in-depth interviews. The fourth objective will involve creating the RTIF prototype and piloting it in the Eastern Region of Ghana. The final and fifth objective shall employ the systems usability scale (SUS) amongst ten randomly selected individual stakeholders to assess the technical functionality of the interface. A nationwide scale-up shall follow this.

유보통합에 관한 시·군·구육아종합지원센터의 기능 및 역할에 관한 질적연구

ThisIn this study, 10 parents of infants and young children, child care teachers, and directors were surveyed to look back on the roles and functions of childcare support centers and to find out the direction for re-establishing the functions and roles of childcare support centers in the new era of integration of early childhood education and childcare. The analysis results are as follows. First, parents are most satisfied with the part-time childcare service for home childcare support, recognized it as a necessary project and expect that it will fulfill its role as a professional organization that can efficiently provide support to improve the quality of education and care of infant education institutions when early childhood education and childcare are integrated. Second, childcare teachers are satisfied with customized consulting support, healing programs, and substitute teacher support and recognize them as necessary projects. Third, directors are satisfied with substitute teacher and childcare staff training, parent education, and counseling projects, and perceived that childcare teachers and parents are growing through various supports. Integration of early childhood education and childcare requires a retraining process for qualification of existing childcare teachers by taking advantage of the geographical accessibility and convenience of si/gun/gu childcare support centers, and educational support to strengthen the expertise of childcare teachers is expected. This study is significant in that it suggests the direction of the functions and roles of childcare support centers so that various services can be efficiently delivered to infant families and infant education institutions in the region at the time when the integration of early childhood education and childcare began

Geospatial Data Analysis of School Distribution in Baghdad City

Education and lifelong learning are necessary components of daily city life for urban communities to encourage sustainable and positive communities. The study attempts to analyze the actual school distribution patterns and densities in Baghdad, the Iraqi capital. The significance of this study is that it is associated with one of the essential aspects of humanity: the improvement and affluence of schooling; it impacts school attendance limitations and educational evolution. The education process has been inextricably tied to students' timely and orderly entrance to their schools. Hence the decision maker and planner are concerned by this. The statistics examined elementary and high schools, and the investigated data are related to the Ministry of Education that was available in 2004. Regarding spatial analysis and results assessment, this work employs Microsoft Excel techniques, ArcGIS, C# simulator, and the buffer methodology. It has depicted the school densities and assessed the distances between them using spatial analytic techniques. The study reveals that the school distribution is uneven, and there is a disparity among neighbors in the spatial distribution. Also, the in-between distances of observed schools formulate four significant patterns. At the same time, this study offers important information about the spatial distribution of schools as a significant influencing indicator. In the future, it will be beneficial to investigate the student's geographical accessibility to their residence and the transportation to/from these schools.

“It’s Gonna Open Up Doors”: Alumni Reflections of Doctoral Community College Leadership Programs

Objective/Research Question: For decades doctoral community college leadership programs have prepared students for the challenges and rewards in steering community college campuses, yet minimal scholarship has explored these programs’ efficacy in serving their students. This study explores community college leaders’ motivations in starting, learning experiences during, and takeaways following participation in doctoral community college leadership programs. Methods: This narrative inquiry study draws on action learning as the theoretical framework and entails interviews with 19 community college administrators who graduated from doctoral community college leadership programs. Results: Findings are threefold, each related to the distinct pieces associated with the research questions at hand. Students’ motivations for enrolling in programing stem from financial and geographic accessibility, institutional credibility, personal fulfillment, and desires to advance their careers. During their time in programs, students benefited from curriculum that prepared them for their dissertations, cohort-based approaches that afforded community, and applicable assignments and activities that directly related to their roles as community college practitioners. Following their doctorate, students reflected on the value of having this degree for propelling their careers and recommended opportunities for programmatic improvement. Conclusion/Contributions: These findings offer new perspective into what doctoral community college leadership programs accomplish in supporting students’ objectives and professional practices, and also unveil ideas toward programmatic adjustments.

INEQUITY ANALYSIS IN THE LOW AND HIGH COMPLEXITY PUBLIC SERVICES SUPPLY IN RELATION TO BEDS AVAILABILITY IN MANIZALES - VILLAMARÍA CONURBATION

This research aims to determine the current conditions of geographical accessibility to and from healthcare centres in Manizales and Villamaría conurbation through the Enhanced two- step floating catchment area (E2SFCA) method, supported by geographic tools and socioeconomic assessments. The main result is that the average number of beds per 1000 inhabitants in low complexity systems is below the average defined for Colombia and Latin America, thus requiring greater attention in implementing beds to reach the required accessibility levels. These valuations allow concluding that the accessibility of healthcare institutions requires the use of significant calculation tools, such as the E2SFCA method, which has not had great applications within the Colombian territory.

Evaluation and bias correction of CRU TS4.05 potential evapotranspiration across vast environments with limited data

Long-term and reliable gridded estimates of potential evapotranspiration (PET) are often dearth. Being the longest available dataset with no validation, this work makes an effort to answer two questions: First, how well does the Climatic Research Unit (CRU) Time-Series (TS) Version 4.05 PET (CRU-PET) dataset capture FAO Penman-Monteith grass reference evapotranspiration (ETo) across a range of environments and, second, can a simple adjustment approach be devised to curb the error, if any? The CRU-PET dataset is evaluated against ETo in two data-scarce countries, namely Sudan and South Sudan. Monthly station data measured at 12 stations spread over hyper-arid, arid, semi-arid and dry sub-humid zones are used. It is shown generally that CRU-PET tends to perform better in dry than wet conditions, and in arid than in humid locations. In this regard, CRU-PET has a tendency to overestimate (underestimate) the stations' values in the arid (humid) zone, with best performance characteristics achieved north of latitude 15° N. Rainfall plays a key role in determining the bias and has a non-linear effect. This bias is, however, unclear in rainless months when both augmented overestimates and underestimates are observed. Incorporating geographical coordinates (latitude, longitude and altitude) as co-variables with monthly rainfall in a multiple linear regression explained 40.7% of the variations in the bias. In this data-scarce study area (>2.5 million km2), this simple adjustment significantly improves the stations' CRU-PET as indicated by eight performance metrics. Furthermore, validation analysis showed a reduction of the overall mean bias error based on the 12 stations from −0.255 to 0.086 mm/day. To apply this correction method on a spatial domain, gridded precipitation data are needed. We used the Global Precipitation Climatology Centre (GPCC 8) dataset, with which 41.9% of the CRU-PET bias is explained. In conclusion, this study cautions the use of CRU-PET dataset without prior evaluation in areas with similar geographical boundaries, climatic conditions and limited availability of data.

Public Policies and Health Services in Establishments with Difficult Geographical Access

This analysis focuses on the effectiveness of government policies in the field of health, specifically in a difficult-to-access region of the Ecuadorian Amazon, classified as type A. It also seeks to uncover the categories and dimensions that intervene in this process. According to the data obtained, 78.8% of the public officials surveyed perceive that public policies present an insufficient level. Of these, 36.4% rate health services as regular, 45.5% consider that infrastructure and equipment are deficient, 33.3% believe that the service portfolio is insufficient, and 66.7% believe that leadership is insufficient. It is concluded that if public policies are oriented and focused more effectively towards difficult-to-access areas type A and B, it will be possible to improve health services, guarantee the service through better infrastructure and equipment, and promote better leadership by the highest authority and the technical administrators of health centers.

Better close to home? Geographical and socioeconomic constraints on gendered educational transitions at the upper secondary level

Educational decisions are affected by geographical accessibility, which may have far-reaching consequences for young people’s future educational pathways. In this paper, we examine the extent to which geographical distance to educational institutions may moderate young people’s applications to upper secondary education in terms of both the track and the gender-(a)typicality of vocational fields of study they apply to. Our study relies on rich register-based data of complete cohorts of 16-year-olds applying to Finnish upper secondary institutions, linked with geographical information on their closest educational alternatives. We find that travel time to the academic track is more decisive than the distance to vocational schools, with geographical accessibility being more significant for boys’ rather than for girls’ application patterns. Moreover, distance sensitivity varied by social origin, with daughters of low-educated parents and sons of medium-educated parents particularly likely to adjust their upper secondary application to the geographical accessibility of educational alternatives. However, we find some indications that particularly girls from lower-educated social backgrounds are more prepared to consider fields of study not typical for their gender if they are more geographically accessible than key alternatives. No such gender-atypical substitutions were evident among boys. We discuss the implications of these findings in the context of explanatory approaches based on risk aversion and (gender) socialization.

BEYOND REDLINING: LAW, PROPERTY VALUES, RACIAL INEQUITIES, AND LTSS

Abstract This presentation will provide background regarding the social construction of property values and the interactive role that public and private institutions have played in creating racial disparities in property values. I will discuss known and proposed mechanisms through which this form of structural racism affects access to long-term services and supports (LTSS) and implications for the health of older adults and their care partners, presenting a specific example from my own research, which found that assisted living communities are located in 30% of communities in America. However, among communities with the highest percent Black population in their county, 31% of those located in counties with a low gap in Black-White economic mobility had access to assisted living, while less than 15% of those located within a county with a high Black-White gap in economic mobility had such access. I will describe how policymakers can use law to address racial disparities in geographic access by developing policies that 1) provide financial incentives for private investors to develop assisted living and other forms of LTSS in neighborhoods that otherwise wouldn’t see development due to low property values; 2) prioritize the location of new buildings in historically marginalized communities; 3) implement anti-displacement measures; 4) incorporate community input and engagement; and 5) ensure accessibility and affordability. Finally, I will describe how policymakers may consider the various actors and institutions that shape the housing market and how they interact with each other to produce outcomes that may reinforce or challenge structural racism.

AGING IN PLACE IN THE RURAL SOUTH

Abstract Aging in place in the rural south involves regionally unique concerns. Understanding the interaction between factors such as geographical isolation, smaller communities, and access to resources is critical for researchers, as results from research in urban areas may not generalize to this population. This symposium will outline regional barriers and protective factors related to aging in place from researchers in a distinctly rural area in the deep south. The symposium will begin with a discussion from Darby Mackenstadt on person-environment fit in a sample of older adults from Mississippi, with an emphasis on predictors of health status such as access to grocery stores and level of education. Carolyn Adams-Price will then review results from qualitative research on older adults’ self-reported attachment to home and local communities in rural Mississippi. Finally, Mary Dozier will give an overview of excessive household clutter as a barrier to maintaining functional independence for older adults enrolled in treatment studies for hoarding disorder in the state of Mississippi.

THE CO-EVOLUTION OF PERSONAL NETWORKS AND LONELINESS FOLLOWING WIDOWHOOD FOR MEN AND WOMEN

Abstract Late-life transitions such as widowhood often re-calibrate people’s close personal networks. Some network change—particularly growth in network size and closer geographic access to network members—is assumed to protect against loneliness, but scholars have yet to systematically examine these processes post widowhood. This study uses data from four waves of the German Aging Survey (DEAS), conducting gender-specific hybrid panel modeling to estimate both within- and between-individual effects of (1) network conditions up to seven years past widowhood, and (2) the effects of network change on loneliness. Results reveal that network size takes on a reversed U-shape: Germans becoming widowed tend to see an influx of new core ties from beyond their family, but this trend slows and reverses with time. There was also some evidence of non-linear change related to distance: geographic distance to core network members tended to shrink following widowhood before expanding back outward. Furthermore, moderation analyses an important role for these network characteristics on loneliness. Larger non-kin networks in the aftermath of widowhood partially alleviated the loneliness associated with that transition. The role of geographic proximity was gender-specific, as widowed men with nearby non-kin ties were most protected against loneliness, whereas widowed women fared best if their kin ties were farther away. Altogether, this study presents novel insight into how personal networks evolve after widowhood, revealing the nuanced, gendered ways that networks adapt. Efforts to reduce loneliness after widowhood may consider how gender roles and expectations shape the transmission and meaning of companionship and support.