Seeking Health Care Research Articles

The use of digital technologies to promote sexual health in young adults: a narrative review

Abstract Background New technologies have the potential to play an important role in promoting sexual health, especially among young people, who are the biggest users and those at greatest risk of contracting Sexually Transmitted Infections (STI). The risk behavior assumed by young people today highlights this vulnerability in several contexts, such as individual, social, economic, and family. In this sense, it becomes relevant to approach sex education in schools using digital technologies. Objectives To identify the evidence in the literature on the use of digital technologies to promote the sexual health of young adults. Methods Narrative literature review. Three independent reviewers extracted, analyzed and synthesized the articles and results. Results Through the selection process, four studies were included. The articles show that the use of digital technologies (mobile phones/applications) leads to increased knowledge, improved attitudes and sexual behavior among young adults. The interventions studied in the studies were based on Short Message Service, electronic mail interventions and the MyPEEPS mobile application, with the following main focuses: Increased knowledge, attitudes, and behaviors of young adults. Considering the results of the studies, all interventions proved to be effective as facilitators of sexual health promotion. Conclusions The use of digital technologies allowed an increase in the promotion of the sexual health of the participants, since there was an increase in the level of knowledge with the use of digital technologies such as SMS, emails and mobile applications when comparing the experimental and control groups. The use of these digital technologies also allowed for a change in attitudes and behaviors, such as a significant increase in serological testing for STIs and an increase in health care seeking. Key messages • The use of digital technology promotes the sexual health of young adults, so these strategies should be implemented by health professionals. • The dissemination of these digital strategies will have an impact on Public Health, specifically regarding the sexual health of young adults.

Impacts of an interpretation fee on immigrants’ access to healthcare: A Danish survey study

Abstract Background In 2018, a fee for healthcare interpretation was introduced for immigrants living in Denmark for more than 3 years to incentivize learning Danish faster. The fee entails out-of-pocket costs ranging from 26-225 EUR per consultation, outpatient visit, or hospital admission. Little evidence is available on how immigrants experience impacts of the fee on their access to healthcare. The study aims to address this gap. Methods Using survey data collected among newly arrived immigrants (n = 486) at 26 cluster-randomly selected language schools in 2021, we analysed prevalence and socio-demographic background of immigrants reporting interpretation needs, and self-reports about whether the fee had caused immigrants to refrain from seeking healthcare, using ad hoc interpreters, and trying to learn Danish faster. Results In the study population, 19% (95% C.I. 14-26%, n = 95) reported interpretation needs. Refugees and their families (OR: 10.2, 95% C.I. 5.3-19.7) more often reported interpretation need compared with EU/EEA immigrants, as did immigrants with low education (OR: 1.9, C.I. 1.2-2.8), low income (OR: 2.6, C.I. 1.6-4.5) or poor self-perceived health (OR: 3.2, C.I. 1.1-9.2), adjusted for gender, age, region of residence, and length of stay. Among immigrants needing interpretation, 42% (C.I. 32-53%, n = 69) reported having refrained from seeking healthcare due to the fee, 73% (C.I. 55-86%, n = 119) using ad hoc interpreters, and 77% (C.I. 59-89%, n = 126) trying to learn Danish faster. Conclusions Findings suggest that the policy aim of incentivizing resettlement country language acquisition is partly met, but that the fee has unintended consequences in terms of hampered access to healthcare and increased use of ad hoc interpreters, raising concerns about unmet health needs and poorer quality of care, especially for vulnerable immigrants. Potential benefits of the policy should be carefully evaluated against severe negative impacts on immigrants’ access to healthcare. Key messages • Healthcare interpretation fees appear to be incentivizing acquisition of the resettlement language, but at the same time severely hamper access to care. • The fee appears to disproportionately affect vulnerable immigrants, including refugees and their families and immigrants with low education, low income, and poor health.

How have respiratory tract infections changed in the post-covid era for children under 5 years?

Abstract Background Social distancing measures introduced in response to the covid-19 pandemic reduced transmission of all respiratory pathogens. Exposure to respiratory pathogens in early life affects future lung health. We aimed to describe changes in the incidence of respiratory tract infections (RTIs) in children <5 years in England in the post-pandemic era. Methods Population-based retrospective cohort study using electronic health records. We included all children aged <5 years registered with a primary care practice from April 2016 to March 2023. We compared monthly GP consultation rates for RTIs in the two post-pandemic years (April 2021 - March 2022 and April 2022 - March 2023) with corresponding months during pre-pandemic years (April 2016 - February 2020). Results There were 3 045 701 respiratory tract infections among 2 894 539 children <5 years registered with a GP practice during the study period. Pre-pandemic, monthly RTI rates varied from lows of 29.1 per 100 child-years in August to highs of 108.8 per 100 child-years in November. In 2021/22, monthly RTI rates were bimodal peaking in June and October, although the winter peak was lower than pre-pandemic years and mean monthly RTI rates were ∼15% lower overall. In 2022/23 mean monthly RTI rates remained ∼15% lower than pre-pandemic years, but there was a single peak in December 2022 of 117.6 RTIs per 100 child-years, exceeding the pre-pandemic winter peaks by 8.1%. Conclusions Overall, monthly RTIs in post-pandemic years were 15% lower than pre-pandemic years. However, there was a concerning peak in December 2022 that exceeded the winter peaks from previous years. Comparisons with national surveillance data suggest this peak reflects changes in RTI incidence, particularly among group A streptococcal infections, but this peak may also reflect changes in access to care or healthcare seeking behaviour. Continued monitoring of post-pandemic seasonal patterns will assist in planning for health service use. Key messages • Respiratory tract infections in children <5 years in post-pandemic years were 15% lower than pre-pandemic years, but winter peaks in incidence may be of greater magnitude in the post pandemic era. • Ongoing monitoring of patterns of respiratory tract infections in young children is important for future health service planning and delivery.

Determinants of health-seeking behaviour in rural district of Jasikan, Ghana: a cross-sectional study

BackgroundThe Ghana Health Service aims to ensure the health of all Ghanaians. Understanding the factors that influence people’s health-seeking behaviour will help the Ghana Health Service evaluate and enact policies that will enable it to achieve set targets. This research aimed to determine the factors that influence the health-seeking behaviour of the residents of Jasikan District and ascertain the importance of the well-being clinic in this context.MethodsThe study design was a community-based cross-sectional study using a mixed method of data collection. A stratified sample of 295 respondents from the five [5] sub-districts of the target population was obtained. Cramer’s V statistic was used to assess the effect size and significance of the association between categorical variables. Further, multiple binary logistic regression was used to determine significant predictors of health-seeking behaviour. Health seeking behaviour was categorised as appropriate or inappropriate. The health seeking behaviour of participants was considered appropriate if they sought health care at public health facilities, private health facilities, and licensed Pharmacies/OTCMS and inappropriate when participants sough care at traditional/faith healers, engaging in self-medication, and not taking action during an illness episode.ResultsThe mean age of participants in the study was 37.49 ± 15.74 years. Females comprised the majority of study respondents (160; 56.3%). When they fell ill, 61% of respondents chose formal public health institutions as the first port of call. A significant proportion of respondents (245; 83%) preferred appropriate health-seeking behaviour, with age (p = 0.045) and health insurance status (p < 0.01) significantly influencing where respondents sought care. More than half of respondents indicated that affordable service (59.9%), readily available drugs (54.5%), and good services (52.0%) are key characteristics of respondents’ preference for service in healthcare. The educational level significantly correlated with service characteristics when people seek health care (p = 0.035). The severity of illness (9; 28.1%), perception of a facility as the best place (7; 21.9%), well-trained staff (4; 12.5%), and professionalism (3; 9.4%) influenced respondents’ choice of health care. More than half (78%) of respondents agreed with the need for a well-being clinic in a hospital. The binary logistic regression indicates that religion is a significant predictor the appropriateness of participants’ health seeking behaviour, but the overall model could not improve the overall prediction rate of the constant model.ConclusionThe health-seeking behaviour of the people of Jasikan is good. The participants’ sex, good service, affordability, and availability of medicines are critical service characteristics that influence the choice of healthcare providers. Managers of health facilities should consider these characteristics to remain competitive and drive positive health-seeking behaviour in the community. Facilities are encouraged to set up a functional well-being clinic and open it to the public.

Understanding the Factors Influencing Adoption of mHealth in Rural Patients: A Case of Embu, Kenya

Background and Purpose: Kenya and other low-income countries face healthcare challenges such as affordability, access, and health worker shortages. Digital technologies have disrupted traditional service delivery in industries such as banking and retail. Significant changes have not yet affected healthcare. Technological advancements in healthcare may help to leapfrog barriers such as the cost of physical infrastructure. The study examined the influence of technical, social, and individual factors in adopting mHealth products in Embu, Kenya. Methods: A cross-sectional quantitative study using a structured close-ended questionnaire was conducted in Embu, Kenya, between August and December 2019. Correlation and regression analysis were used to determine the effect of the influential factors on adopting mHealth products. Results: 207 (75%) randomly selected respondents over 18 years completed the survey, with the largest group (39.4%) aged between 35-44 years and 43% holding a post-secondary school diploma. Correlation analysis showed that social factors positively and significantly correlate to mHealth products' adoption (r (207) = .793, P &lt; .05), reflecting a generally favourable view towards using mobile phones for seeking healthcare. Similarly, technical factors showed a significant correlation with mHealth adoption (r (207) = .931, P &lt; .05), supported by widespread smartphone ownership and access to high-speed internet. Individual factors, including perceptions of the time-saving benefits of seeking healthcare services using a mobile phone, also demonstrated a positive correlation with the adoption of mHealth (r (207) = .708, P &lt; .05). Conclusions: Our study underscores the significant relationship of social, technical, and individual factors in adopting mHealth products. Digital health implementers should leverage increasing access to technical factors such as the Internet, smartphones, good mobile network coverage, and high utilization of social media to facilitate the positive adoption of mHealth. Our research provided insights from Embu; however, expansive studies encompassing rural and urban demographics are required to enhance generalizability

Factors influencing delayed cancer health seeking in Meghalaya, Northeast India: A qualitative study

Background &amp; objectives India accounts for about seven per cent of the global cancer burden with the highest cancer incidence reported from the North-Eastern Region (NER), including Meghalaya. Despite this, there is paucity of published studies on health seeking behaviour for cancer in the NER. To address this gap, this study used a qualitative approach to document patient, caregiver and provider perspectives to understand the factors influencing healthcare seeking for cancers in Meghalaya. Methods In-depth interviews were undertaken with 37 individuals diagnosed with one of the top five cancers in Meghalaya, namely, oesophageal, breast, oral, cervical and lung cancer. They were identified from the State referral cancer hospital. Twelve caregivers and five healthcare providers were also interviewed. All interviews were conducted in the local language using semi-structured interview guides. Transcripts were translated to English, coded, categorized and analyzed using thematic framework content analysis approach. Results A key factor influencing delayed cancer treatment in Meghalaya included misconceptions regarding the causes of cancer and cultural concepts such as bih and skai (Khasi language), i.e. notions of a figurative ‘poison’ or ill intent that makes one susceptible to illness. A general reluctance to discuss cancer diagnoses, perceived stigma, apprehension of treatment methods influenced their decision. Other factors included negligence and misinterpretation of early symptoms of cancer, self-management, preference for traditional medicines, financial constraints and health system-related factors. Interpretation &amp; conclusions This study underscores the importance of addressing barriers to cancer diagnosis and treatment in indigenous populations in northeast India, advocating for culturally appropriate messaging, capacity building for healthcare workers, integration of traditional healers, and community involvement to enhance early healthcare seeking and improve outcomes.

Health Disparities and the Influence of Culturally Competent Care in Overall Health and Healthcare Utilization among Hispanics in a Southeastern US Community.

Introduction: This study sought to assess disparities in health/healthcare utilization for Hispanic immigrant community in Greenville County, SC. The study also assessed the role of culturally competent care perceptions on health/healthcare utilization within this growing community. Methods: Secondary administrative data collected by a large health care system in the county facilitated the assessment of health/healthcare utilization disparities using multivariate regression. Primary purposive surveys collected among Hispanic adults assessed culturally competent care perceptions and health/healthcare utilization. Culturally competent care measures included: (1) provider understanding, (2) provider communication behaviors, (3) provider assurance, and (4) interpreter service access. Results: Health disparities were present, with Hispanic residents having lower overall health and lower routine healthcare seeking behaviors compared to non-Hispanic White residents. Moreover, culturally competent care perceptions influenced overall health and healthcare-seeking behavior within this growing Hispanic community. Hispanic residents who perceived negative communication behaviors, lack of assurance, and increased interpretive service barriers reported lower overall health and lower routine healthcare seeking behaviors. Conclusions: Addressing potential cultural competency barriers may reduce health disparities among underrepresented racial/ethnic communities as they grow and become established in the Southeast, while also improving broader health equity for all communities.

Changes in healthcare seeking behaviors among caretakers of children in the previously occupied ISIS territory: Hadeetha, Anbar, Iraq: a cross-sectional survey of 415 households.

The western province of Anbar, and the district of Hadeetha, have suffered direct impacts from the second United States led invasion (2003) through the ISIS invasion (2014-2017). With the primary health care centers being closed or inaccessible, the remaining population experienced changes in health seeking. The area of Anbar, Iraq remains largely remote from the discourse of health system recovery post-conflict. The objective of this study was to describe changes in health seeking behaviors of caregivers of children ages 12-72months of age in Hadeetha, Anbar, Iraq from the conflict period of ISIS (Islamic State of Syria and Iraq), 2014-2017, to the post-conflict period, 2021. This was a mixed-methods study composed of a cross-sectional 415 household survey and focus groups in Hadeetha, Anbar, Iraq. Caretakers of children were interviewed from February to April 2021. Children were sampled from a list of children who missed at least one vaccination appointment without a return for follow-up from the birth cohorts of 2014 to 2020. Healthcare workers focus groups and key informant interviews occurred from 2019 to 2021 centered around experiences from the 2014 to 2021 period. In the post-conflict period, there were no differences in health seeking based upon provider type between respondents. Physicians were primary healthcare providers in the post-conflict period for 79% of respondents versus only 47% in the conflict period. Healthcare workers described major barriers to delivering services in Hadeetha during the ISIS occupation due to infrastructure damage, threats of violence, decreased medical personnel, lack of compensation and disruptions in medical supplies from 2014 to 2017. This study provides insight into health seeking challenges among the many individuals who remained in Hadeetha during the ISIS occupation. Health use patterns by provider type mirror the concerns the healthcare providers shared: limited availability, efflux of professional workers, limited resources and security challenges to providing care. Positive trends toward increased access to physicians during periods of peace are an encouraging marker for continued population resilience during the post-conflict period. Recovery efforts continue to be hampered by internal sectarian discord within Iraq as well as insufficient resources to maintain health services as well as provide catch-up health services, such as immunizations.

Health care seeking behaviour of patients reporting to a dental health Institution- A cross sectional study

This study aimed to assess the factors influencing healthcare-seeking behaviour among patients presenting to a dental institution. Oral diseases, such as dental caries and periodontal diseases are prevalent global health concerns, particularly in developed countries, whereas oral cancers are more common in developing countries. In India, there is observed lower utilization of dental care services and higher rates of dental problems. This descriptive study involved 220 patients who visited a dental college and hospital in India. Patients were interviewed to gather information on their chief complaint, history of previous treatment for the complaint, and reasons for delaying dental treatment. The study identified several key factors contributing to delays in seeking dental treatment. Negligence was cited by 27.1% of patients, absence of symptoms by 14.5%, and financial constraints by 9%. Gender, occupation, and education level of patients also showed varying impacts on healthcare-seeking behaviour. Negligence, lack of symptom awareness, and financial constraints, particularly in rural and suburban areas were the significant barriers to timely dental treatment among patients in a dental institution in India.

Healthcare-seeking behavior for diarrhea in under-five children and associated factors in sub-Saharan Africa: a multilevel robust Poisson regression model.

Diarrhea is one of the leading causes of child death in sub-Saharan Africa (SSA). Children with diarrhea who do not receive medical advice or treatment are at high risk of poor health outcomes and increased mortality. Prompt and adequate treatment is essential to mitigate these risks. However, studies that have been conducted on the factors influencing healthcare-seeking behavior (HSB) for diarrhea in under-five children in SSA are scarce. Therefore, the purpose of this research was to determine the variables related to HSB for diarrhea in children under the age of five. A secondary data analysis was conducted on the most recent data from the Demographic and Health Surveys in 35 SSA countries. The study included a total weighted sample of 51,791 children under the age of five with diarrhea. We presented the adjusted prevalence ratio and the 95% confidence interval in the multivariable multilevel robust Poisson regression analysis to show the statistical significance and strength of the association between HSB and its determinants. The pooled prevalence of HSB for diarrhea in under-five children was 58.71% (95%CI: 55.39 to 62.04). Factors found to be associated with HSB included maternal age, education and working status, antenatal care visits, postnatal checkups for the child, wasting, distance to a health facility, SSA region, and country income level. More than 40% of under-five children with diarrhea in SSA did not receive medical advice or treatment. To improve healthcare-seeking behavior, effective health policy interventions are necessary. These include enhancing the education and employment status of mothers, promoting regular antenatal and postnatal care visits, building health facilities in close proximity, and raising awareness in the community about the importance of seeking healthcare services for malnourished children.

Adherence to referral advice and its associated factors among community drug distributors and caregiver during SMC implementation in nine states

BackgroundMalaria is a global public health problem that disproportionately affects under-five children in poor resource countries. Nigeria accounted for the highest burden of malaria in Western Africa. Thus, seasonal malaria chemoprevention (SMC) programmes have been recommended and have been implemented across 9 states (Bauchi, Borno, FCT, Kebbi, Kogi, Nasarawa, Plateau, Oyo and Sokoto) in Nigeria. The study aims to measure the adherence to referral protocol and its associated factors among community drug distributors (CDs) and caregivers during SMC implementation in nine states.MethodsThe data of caregiver-child pairs that were identified with fever during the cycle one SMC implementation was extracted from the End-of-cycle (EoC) surveys carried out following cycles one SMC implementation in the study states. The surveys were completed within two weeks of the completion of SMC cycle one. Mixed-effects multivariable logistic regression models were fitted to explore the factors associated with adherence to referrals among caregivers-child pairs.ResultsThe socio-demographic characteristics of caregiver considered in the model were not found to be significantly associated with children down with fever taking to hospital for treatment, however the caregiver whose child was referred by CDs had significantly higher odds of seeking healthcare compared to those that were not referred (OR: 1.892, 95% CI 1.081–3.310, p = 0.025). There are higher odds of children seeking treatment among those that were referred by CDs.ConclusionThe study's findings shed light on the adherence to referral advice and the factors influencing caregiver behaviour during SMC implementation. Referral of sick child during SMC campaign appears to ensure health-seeking for malaria case management among caregivers-child peer in target communities.

Late diagnosis among patients with prostate cancer at the Uganda Cancer Institute: a retrospective cohort study

Background: Late diagnosis of prostate cancer is associated with high mortality, morbidity and low quality of life. We aimed to assess the time of diagnosis among prostate cancer patients in Uganda and investigate the factors associated with early or delayed diagnosis. Methods: A retrospective cohort analysis of 280 records of patients with histologically confirmed diagnosis of prostate cancer from January 2016 to December 2017. Delayed diagnosis was defined as the diagnosis done at stage III or IV. Stage I and II were classified as early. We used modified Poisson regression to assess factors associated with early or delayed diagnosis. Results: The median from symptom recognition to diagnosis was 12 months (Interquartile Range, IQR: 5-24), with 76% of patients receiving their diagnosis more than 4 months after experiencing symptoms. Notably, 35.7% of patients were diagnosed at stage III, and 46.1% at stage IV. Upon diagnosis, all patients exhibited elevated prostate-specific antgen (PSA) levels with median PSA of 100.2 ng/ml (IQR: 36.02-350) in blood. Conclusion: Taking a biopsy after 4 months of initial symptoms was partially responsible for the delay in diagnosis. Communities should be educated about prostate cancer symptoms and advised to seek health care early. Health care workers should be sensitized to suspect prostate cancer among patients to allow timely referral. Keywords: Diagnosis; prostate cancer; Uganda; timing; late diagnosis.

Underreporting of violence against women: an analysis of two data sources.

This article aims to estimate the underreporting of violence against women (VAW) in the Notifiable Diseases Information System (SINAN), based on data from the National Survey of Health (NSH), in Brazil and subnational units (SU). This work was an ecological study using SINAN and NSH, both from 2019. In SINAN, reports of sexual, physical, and psychological VAW, aged 18 years or older, were selected. In the NSH, women of the same age group who reported psychological, physical, or sexual violence, and who had sought health care due to consequences of the violence were selected. SINAN underreporting was calculated in reference to the NSH's estimated population, for Brazil and each SU. Underreporting of VAW in Brazil was 98.5%, 75.9%, and 89.4% for psychological, physical, and sexual violence, respectively. The North and Northeast states presented the lowest reporting rates among the states. VAW in Brazil is highly underreported by the health sector, showing the need for adequate training of health professionals to recognize situations of violence and raise awareness of the importance of reporting.

Improving access to Sexual and Reproductive Health services among adolescent women in Zimbabwe.

Unplanned pregnancies increased among adolescents in Zimbabwe, resulting in unsafe abortions; Sexual and Gender-based Violence, and forced marriages. Access to Sexual and Reproductive Health and Rights has been scanty among pregnant adolescents and adolescent mothers owing to negative social norms; stigma and discrimination. This project specifically targeted pregnant adolescents and adolescent mothers through a differentiated and targeted care approach to improve uptake and sexual and reproductive health outcomes.Target specific peer support groups for the pregnant adolescents and adolescent mothers were established in Epworth district of Zimbabwe. The Champions of change, peer-based approach was used to facilitate comprehensive sexuality education. Mentors were adolescent mothers trained on how to use a tailored-made manual to facilitate sessions. Two health centers namely Epworth clinic and Overspill clinic were purposively selected to participate in this study. A total of 60 participants were recruited into this study, 30 from each clinic. Knowledge and attitude were measured using a semi-structured questionnaire administered before and after the intervention. A score-card was used to assess friendliness and quality of service provision. A Chi-square test of association was used to determine the significance of the change in outcomes. A significant improvement in knowledge on SRHR, attitudes and health care seeking behaviors was noted. There was a significant improvement attitudes and friendliness in service provision. Access to services significantly increased with improvement in relationships and trust.

Mental Health Treatment-Seeking Appraisal, Afrocentric Cultural Norms, and Mental Health Functioning: Buffering Factors of Young Black Men's Externalizing Behavior.

Depression rates are disproportionately high among Black American Men. This disparity--compounded by low mental healthcare seeking rates and high incorrect diagnosis rates in men--could be related to masculine norms, including self-reliance, restrictive emotionality, and stoicism. Furthermore, men are more likely to engage in externalized behavior, such as aggression, to cope with mental health challenges; this pattern is influenced by cultural and environmental factors. Contrary to these detrimental factors, social relationships, belief in social networks, and collectivism have been associated with positive mental health in these populations. Similarly, an Afrocentric worldview (including concepts like Ubuntu and African self-consciousness) has been hypothesized to promote positive mental health outcomes among Black American men. However, little research exists on harnessing these factors as a means of increasing health-seeking behaviors in young Black males. To elucidate the effect of region, depression, African humanism, collectivism, and help-seeking values and needs concerning aggression in young Black males. This study included Black or African American participants (n = 428) identifying as male, aged 18-25 years, who responded to a Qualtrics survey with questions on region, aggression, depression, African humanism, collectivism, and help-seeking value and need. Hierarchical linear regression revealed that collectivism, humanness, value, and the need for seeking treatment were inversely associated with aggression (p < 0.001). Highlighting the effect of cultural norms and help-seeking behaviors and the aggravating effect of depression on aggression in young Black males can help to develop aggression-mitigating interventions rooted in Afrocentric Norms.

Evaluating the Quality of Screening Process for High-Risk Pregnancies in Paser District, East Kalimantan

Health service programme success is measured by maternal mortality. There have been efforts to reduce maternal and neonatal fatalities. Field observations suggest that high-risk pregnancy referral rates are still low, delaying access to better services. Screening for high-risk pregnancies is an operational technique to prevent maternal and newborn emergency issues by allowing early treatment and referral planning. Health cadres and personnel can provide quality information. Lack of knowledge and awareness will harm society, especially pregnant women, in dealing and seeking health care. This study uses descriptive methods to assess high-risk pregnancy screening in Paser Regency, East Kalimantan, by collecting individual data and watching written and verbal behaviour. This research is qualitative and phenomenological. Health workers, ob-gyns, GPs, and pregnant women were informants. The data was collected through interviews from November to December 2023. The research found that high-risk pregnancy screening was still poor due to lack of knowledge, understanding, staff, time, site, and community culture. This research aims to improve high-risk pregnancy screening in Paser Regency, East Kalimantan Province, so that the policy can become permanent and help the planned referral process by motivating, socialising, training health cadres, and requiring cross-sectoral and cross-program support.

Factors Affecting Health Seeking Behavior of Elderly People in a Community of Pokhara, Nepal

Introduction: Individuals have different opinion regarding willingness to seek help from health care services. Thus, a study aimed to find out the health care seeking behaviour, factors affecting health care seeking behaviour and association between health seeking and those factors among elderly people. Methods: Cross-sectional analytical study was conducted among 197 elderly people of 65 years and above in Pokhara Metropolitan City Ward No.28. Non probability purposive sampling technique was used. Data was collected by face to face interview technique using self-developed structured interview schedule. SPSS 16 was used for data analysis. Descriptive statistics frequency, percentage, mean and standard deviation were used for data analysis. Inferential statistics (Chi-square test) was used to reveal the association between the selected factors and health seeking behaviour.. Results: Finding showed 77.66% of respondents sought appropriate health care where as only 22.34 % of respondents sought inappropriate health care. Among those who sought care from appropriate health care, 65.48% of respondents sought care from governmental hospital. Among those who sought inappropriate health care still 22.72 % of respondents had belief in traditional healer. Accompany for the treatment of elderly was found statistically significant and other factors was not found statistically significant Conclusion: Based on the findings more than two third of the respondents reported that they seek appropriate health care. Among those respondents nearly half of respondents’ reason for seeking appropriate health care was good experience of medical treatment in the past. Among those whose health seeking behaviour is inappropriate, still one fourth of respondents had belief on traditional healer. Key words: Health seeking behavior; Elderly people; Nepal

Impact of NHI copayment adjustments on healthcare seeking behavior: the mediating role of health facility identification

ObjectiveThis study investigates the impact of healthcare consumers’ involvement, price perception, and attitude toward National Health Insurance (NHI) copayment adjustments on their healthcare-seeking behavior, focusing on the mediating role of health facility identification.MethodsA questionnaire survey was conducted among outpatient customers in Taiwan from October 2023 to March 2024, resulting in 746 valid responses. The survey included demographic variables, involvement, price perception, attitude, health facility identification, and healthcare-seeking behavior. Data were analyzed using descriptive statistics, correlation analysis, and multiple regression analysis with SPSS 20.0.ResultsThe study found that involvement, price perception, and attitude significantly influence healthcare-seeking behavior. Health facility identification was identified as a significant mediator in the relationship between copayment perception and healthcare-seeking behavior. The regression analysis also highlighted the impact of demographic factors such as age, education level, marital status, and annual income on healthcare-seeking behavior. The path model illustrated the complex interplay between perceptual factors and their influence on healthcare-seeking behavior.ConclusionThis study emphasizes the importance of consumer involvement, price perception, and attitude in shaping healthcare utilization patterns. Health facility identification plays a crucial mediating role, suggesting that stronger patient-provider relationships can mitigate potential negative impacts of copayment adjustments. Policymakers and healthcare providers should enhance patient engagement, foster strong patient-facility identification, and provide targeted support for vulnerable groups to ensure equitable access to healthcare services despite copayment changes.

Healthcare Seeking and Self-Medication Trends Pre- and Post-COVID-19: Insights from a Tertiary Care Hospital in Hubli, Karnataka.

Healthcare Seeking and Self-Medication Trends Pre- and Post-COVID-19: Insights from a Tertiary Care Hospital in Hubli, Karnataka.

Health workforce needs in Malawi: analysis of the Thanzi La Onse integrated epidemiological model of care

BackgroundTo make the best use of health resources, it is crucial to understand the healthcare needs of a population—including how needs will evolve and respond to changing epidemiological context and patient behaviour—and how this compares to the capabilities to deliver healthcare with the existing workforce. Existing approaches to planning either rely on using observed healthcare demand from a fixed historical period or using models to estimate healthcare needs within a narrow domain (e.g., a specific disease area or health programme). A new data-grounded modelling method is proposed by which healthcare needs and the capabilities of the healthcare workforce can be compared and analysed under a range of scenarios: in particular, when there is much greater propensity for healthcare seeking.MethodsA model representation of the healthcare workforce, one that formalises how the time of the different cadres is drawn into the provision of units of healthcare, was integrated with an individual-based epidemiological model—the Thanzi La Onse model—that represents mechanistically the development of disease and ill-health and patients’ healthcare seeking behaviour. The model was applied in Malawi using routinely available data and the estimates of the volume of health service delivered were tested against officially recorded data. Model estimates of the “time needed” and “time available” for each cadre were compared under different assumptions for whether vacant (or established) posts are filled and healthcare seeking behaviour.ResultsThe model estimates of volume of each type of service delivered were in good agreement with the available data. The “time needed” for the healthcare workforce greatly exceeded the “time available” (overall by 1.82-fold), especially for pharmacists (6.37-fold) and clinicians (2.83-fold). This discrepancy would be largely mitigated if all vacant posts were filled, but the large discrepancy would remain for pharmacists (2.49-fold). However, if all of those becoming ill did seek care immediately, the “time needed” would increase dramatically and exceed “time supply” (2.11-fold for nurses and midwives, 5.60-fold for clinicians, 9.98-fold for pharmacists) even when there were no vacant positions.ConclusionsThe results suggest that services are being delivered in less time on average than they should be, or that healthcare workers are working more time than contracted, or a combination of the two. Moreover, the analysis shows that the healthcare system could become overwhelmed if patients were more likely to seek care. It is not yet known what the health consequences of such changes would be but this new model provides—for the first time—a means to examine such questions.