Area Health Service Research Articles

Utilization of maternal health services in rural Thawang, Rolpa district of Nepal: a community-based cross-sectional study

PurposeThis study aimed to identify the proportion and factors influencing the use of maternal health services (MHS) in rural Thawang, Rolpa, Nepal.Design/methodology/approachThis was a community-based cross-sectional study conducted among 417 mothers who had given birth in the previous two years. Bivariate and multivariate logistic regression was applied to identify associations and predictors.FindingsThe results showed that the use of maternal health services was 50.8%. Adjusting for all other factors in the final model, age group 25–30 years (AOR: 2.30; 95% CI: 1.199–4.422), spouse communication (AOR: 7.31; 95% CI: 2.574–20.791), high accessibility (AOR: 2.552, 95% CI: 1.402–4.643) and high affordability (AOR: 10.89; 95% CI: 4.66–25.445) were significant predictors.Research limitations/implicationsThis is a community-based cross-sectional study, and hence cannot establish causal relationships. The research was conducted in a limited rural area mid-Western Nepal, and this may limit the generalization of results to other settings of the country.Practical implicationsThis research supports to local level government and district health authority to develop and implement need based action to increase maternal health service in the local context.Originality/valueUnderutilization of maternal health services is the result of socioeconomic dynamics, poor access to health services and other physical developments. To increase utilization of maternal health services in rural areas, there is a need to tackle the root cause of health inequality such as reducing poverty, increasing female education, involving women in employment and increasing access to health as a priority development agenda by government authorities. This research supports local level government and district health authorities to develop and implement needs-based action to increase MHS in the local context.

Small Area Analysis of Veterans Affairs Mental Health Services Data.

To identify geographic variation in mental health service use in the Department of Veterans Affairs (VA), the authors constructed utilization-based VA mental health service areas (MHSAs) for outpatient treatment and mental health referral regions (MHRRs) for residential and acute inpatient treatment. MHSAs are empirically derived geographic groupings of one or more counties containing one or more VA outpatient mental health clinics. For each county within an MHSA, patients received most of their VA-provided outpatient mental health care within that MHSA. MHSAs were aggregated into MHRRs according to where VA users in each MHSA received most of their residential and acute inpatient mental health care. Attribution loyalty was evaluated with the localization index-the fraction of VA users living in each geographic area who used their designated MHSA and MHRR facility. Variation in outpatient mental health visits and in acute inpatient and residential mental health stays was determined for the 2008-2018 period. A total of 441 MHSAs were aggregated to 115 MHRRs (representing 3,909,080 patients with 52,372,303 outpatient mental health visits). The mean±SD localization index was 59.3%±16.4% for MHSAs and 67.8%±12.7% for MHRRs. Adjusted outpatient mental health visits varied from a mean of 0.88 per year in the lowest quintile of MHSAs to 3.14 in the highest. Combined residential and acute inpatient days varied from 0.29 to 1.79 between the lowest and highest quintiles. MHSAs and MHRRs validly represented mental health utilization patterns in the VA and displayed considerable variation in mental health service provision across different locations.

A Health Support Model for Suburban Hills Citizens

In spite of the increasing understanding of the importance of social support attached to health and medical services in suburban areas, a support model needs to be established that can benefit those areas with different living patterns. To that end, this research employs both quantitative and qualitative analyses to investigate the medication, social support, and care forms and sources in the suburban hills of an area in a central Taiwan village. Different types of data sources were collected during the analysis phase to develop a support model. A new model integrated with the boundaries between the demander and the provider was developed. An experimental mobile app was also developed, and this app was based on the concept of this new support model. It is hoped that the medicine service, care support, and key information on society health activities could be provided by means of using the easiest and simplest GUI through which the local healthcare economic system could be further established.

Access to Healthcare Following Serious Injury: Perspectives of Allied Health Professionals in Urban and Regional Settings.

Barriers to accessing healthcare exist following serious injury. These issues are not well understood and may have dire consequences for healthcare utilisation and patients’ long-term recovery. The aim of this qualitative study was to explore factors perceived by allied health professionals to affect access to healthcare beyond hospital discharge for people with serious injuries in urban and regional Victoria, Australia. Twenty-five semi-structured interviews were conducted with community-based allied health professionals involved in post-discharge care for people following serious injury across different urban and regional areas. Interview transcripts were analysed using thematic analysis. Many allied health professionals perceived that complex funding systems and health services restrict access in both urban and regional areas. Limited availability of necessary health professionals was consistently reported, which particularly restricted access to mental healthcare. Access to healthcare was also felt to be hindered by a reliance on others for transportation, costs, emotional stress and often lengthy time of travel. Across urban and regional areas, a number of factors limit access to healthcare. Better understanding of health service delivery models and areas for change, including the use of technology and telehealth, may improve equitable access to healthcare.

Increasing School-Based Mental Health Services with a "Grow Your Own" School Psychology Program.

There is a nationwide shortage of school psychologists, and while NASP has recommended ways to increase recruitment and retention, the research on recruiting and retaining school psychologists, especially in high-need areas, is limited. Teacher education researchers have begun to address teacher shortages through “grow your own” training programs, but the research on these programs is also limited. A team of university school psychology faculty and regional education agency administrators developed a “Grow Your Own” school psychologist re-specialization training program to support recruiting and retaining school psychologists in rural areas. It is difficult for rural education agencies to recruit young professionals to their area, but it may be possible to recruit professionals currently living in the area to school graduate training programs. The partnership between the university school psychology training program and the regional education agencies addresses the school psychology shortage in one Midwestern state by recruiting special education and related educational professionals to school psychology. A focus of this program is to place more mental health professionals (i.e., school psychologists) in rural schools, therefore addressing the deficiency of mental health services in these rural areas. The partnership and the program are described, as are opportunities and challenges that the team has experienced to date.

Analysis of Trends in the Development of Availability of Medical Services for Rural Population

The article summarizes the arguments and counter-arguments within the scientific discussion on the availability of medical services for the rural population. The main purpose of the study is to analyze the current principles of state policy of Ukraine in the field of health and accessibility and quality of health care in rural areas. Systematization of literature sources and approaches to solving the problem of access to health services has shown that many problematic issues in the field of access to health services in rural areas in Ukraine and around the world, related to investment, personnel management and effective government regulation. The urgency of solving this scientific problem is that medical care should be provided in all regions and agglomerations of the country equally effectively and focus on patient requests. The study of the availability of medical care in rural areas in the article is carried out in the following logical sequence: bibliometric analysis of research, the next step is a survey of consumers of medical services on the basis of the district hospital; analysis of the results of the survey of respondents; providing guidance on key health issues and areas. The methodological tools of the study were survey methods and expert assessments, comparative and bibliometric analysis, the study period was chosen 2011-2021. The object of the study was the Sumy Central District Clinical Hospital, as it provides services to patients living in rural areas. The study empirically confirms and theoretically proves that there are problems with having a family doctor in families, as 1% of respondents indicated that they do not have a family doctor and have not consulted him, while more than half of respondents are satisfied with the result of a doctor’s visit, however, a significant share did not indicate the exact answer, which gives reason to think about the existing problems that led to such results. The results of the study can be useful for further research and recommendations for future opportunities to effectively influence the development of access to health services in rural areas and at the same time improve and enhance the quality of services provided in cities.

Nurse practitioner locums: a plausible solution for augmenting health care access for rural communities.

With 2020 being designated the Year of the Nurse and Midwife, it is opportune to acknowledge and recognise the role that nurses undertake in primary care environments. Nurses and midwives play a pivotal role in the delivery of high-quality health care, particularly in geographically challenged areas of Australia, where they may be the only provider of care within their communities. Rural and remote health services require strategic planning to develop and implement solutions responsive to the challenges of rural and remote communities. Maintenance of health services in rural and remote areas is a challenge, crucial to the equity of health outcomes for these communities. Many small communities rely on visiting medical officers to provide the on-call care to facility services, including emergency departments, urgent care centres, acute wards and aged care facilities. It is increasingly difficult to maintain the current rural workforce models, particularly the provision of after-hours 'on-call' care necessary in these communities. An alternative model of health care service delivery staffed by nurse practitioners (NP) is one proposed solution. NPs are educated, skilled and proven in their ability to provide an after-hours or on-call service to meet the expectations of rural and remote communities. Achievement of high-quality health care that is cost-efficient, safe and demonstrates improved patient outcomes has been reported in NP-led health care delivery impact evaluations. The value of an NP locum service model is the provision of a transparent, reliable service delivering consistent, equitable and efficient health care to rural and remote communities.

Perceived Barriers to Mental Health Services among the Elderly in the Rural of Vietnam: A Cross Sectional Survey in 2019.

While the burden of neurological and mental disorders has been drastically increased in Vietnam, the current mental healthcare services do not meet the public demand. In order to determine perceived barriers to the use of mental health services, we conducted a cross-sectional study on 376 elderly people from a rural district in Hanoi, Vietnam. We found that depression may be an important indicator of the need for formal and informal community and home care mental health services. Barriers to mental healthcare access were categorized into 7 groups namely stigma, emotional concerns, participation restrictions, service satisfaction, time constraints, geographic and financial conditions, and availability of services. The most significant barriers are the limited availability of and accessibility to health professionals and services in rural areas. Our study highlights the urgent efforts that need to be made in order to enhance availability of mental healthcare services in rural areas of Vietnam.

Computer Aided Diagnosis Based on Artificial Intelligence in Providing Support for Health Services in Rural Areas

The health service system in Indonesia is still a homework that needs to be addressed by the government. Both in terms of equity, regulation, and integration between offline and online systems. As for what is happening now, there are at least some obstacles that need to be addressed and addressed as soon as possible. On the other hand, health development should beseen as an investment to improve the quality of human resources and support economic development, and have an essential role in poverty reduction efforts. Today’s primary health development problems include the high disparity in health status between socioeconomic levels, regions, and urban and rural areas. In general, the health status of people with high socioeconomic levels in western Indonesia and urban areas tends to be better. On the other hand, the health status of people with low socioeconomic status in eastern Indonesia and rural areas is still lagging. The quality, equity, and affordability of health services are also still low. The quality of service is an obstacle because medical personnel is minimal and equipment is inadequate. In terms of numbers, the ratio of health workers to the population to be served is still low. The affordability of services is closely related to the number and distribution of healthfacilities. In terms of the limitations of medical equipment, this is due to the high price of the medical equipment. Besides, special training is also needed in medical equipment, which training takes quite a long time, and the material is quite complex. With these conditions, it is necessary to optimize technology to develop medical equipment, especially diagnostic support equipment that is cheap, easy to use, and has high accuracy. Our research aims to address optimizing image processing technology and artificial intelligence in developing technology to support health services in rural areas. We tried to implement several cases of health services that often occur in rural areas, namely early detection of cataracts, optimizing the use of ultrasound machines, optimizing the use of lowquality MRI machines in the diagnosis of Alzheimer’s, using microscopic images to identify leukocytes and using X-ray images to support the diagnosis. COVID19. Of the several modulesthat we have developed for health care support technology, the results show promisingprospects with a good level of accuracy, ease to use, and use modalities that already exist in the lowest health service units to reduce prices. It is hoped that this image processing and artificial intelligence-based health service support module can be used in rural areas to overcome disparities in health services in Indonesia.

Public administration in the area of public health service in the Polish-Lithuanian period

Public administration in the area of public health service in the Polish-Lithuanian period

Does Fiscal Transfer Improve the Equalization of Regional Public Health Service Evidence from a Spatial Panel-Data Analysis in China

Public health service is regarded a key social resource contributing to the national health and sustainable development. Its development gap, however, exists among regions in China due to the unbalanced regional economy, and is also affected by financial distribution. With the effect of tax reform, central fiscal transfer has become a strategic approach to narrow the regional gap of public health service and improve the regional development. This paper aims to evaluate provincial public health service levels in China by applying entropy method and shows that obvious spatial imbalance of public health service level exists in Chinese provinces and such imbalance is also consistent with that of average fiscal transfer from the central government to the regional ones. The current research also looks at, by adopting spatial panel model, a model developed from economic convergence model, whether central fiscal transfer effectively helps to lower the level of public health service difference in regions and the outcome depicts that central fiscal transfer, particularly fiscal transfer for specific purposes, accelerates Chinese public health service development especially in eastern, middle and western regions. From the perspective of spatial effect, neighborhood imitation effect exists to allow completion among neighboring regional governments and therefore more investment to public health service. Compared with the pace of economic development, central fiscal transfer’s limited effect is still seen in less developed regions particularly some midland and western areas, due to the inadequate investment rooted in government’s structured expenditure plan. The implication of this research is that, apart from the attention to economic growth, the government should, with the effort of fiscal transfer, financially focus more on the area of public health service.

Assessment of Nigerian blood transfusion centers' capacity for provision of convalescent plasma for treatment of SARS-CoV-2 infected patients

Background and Objectives: With the data from small clinical trials leading to the emergency authorization of convalescent plasma (CP) as one of the treatment options of coronavirus disease 2019 (COVID-19) in the United States, countries across the world are likely to key in as the race toward discovering evidence-based treatment and vaccines continues. We assessed Nigerian blood transfusion services' preparedness to provide CP support for patients with moderate-to-severe acute respiratory syndrome coronavirus 2 infection. Materials and Methods: We conducted an online survey using a questionnaire designed to assess the Nigerian blood centers' existing capacity. Forty-two tertiary facilities were selected, and a questionnaire was E-mailed to the selected blood bank staff of each center. Responses were collated and analyzed using descriptive statistics. Results: The majority of the facilities had neither apheresis (73.5% [25 of 34]) nor cold centrifuge (55.9% [19 of 34]) for blood components collection or preparations. Family replacement blood donors contributed 51%–90% of the donations in 70.6% (24 of 34) of the centers. Only 2.9% of the centers had an existing capacity for using nucleic acid to screen transfusion transmissible infections, and only one center reported the capacity for pathogen inactivation of blood components. None of the centers provide leukodepletion for blood components. Conclusion: At the current state, Nigerian blood transfusion services are incapable of providing adequate and safe CP for COVID-19 treatment. Efforts should be made to invest in this critical health service area to take advantage of the readily available CP to reduce mortality and morbidity associated with the COVID-19 pandemic, and other disorders.

Beneficiary satisfaction with mobile medical units in the state of Andhra Pradesh

Background: Mobile health services in India have gained significant attention recently. However, there is little information regarding the beneficiary satisfaction of such services. Beneficiaries’ satisfaction and perception plays significant role in utilization of services. We assess the program beneficiaries’ satisfaction of using mobile health services in rural Andhra Pradesh.Methods: We used a cross-sectional study design to survey the mobile health services program beneficiaries in rural Andhra Pradesh (October 2016 to October 2018). Beneficiaries availing the mobile health services from 277 mobile medical vans across 13523 villages were selected using multistage sampling. Exit interviews (using Likert-scale questions) were used to reveal the ease of access in utilising mobile health services and satisfaction among the program beneficiaries.Results: A total, 1080 exit interviews were conducted. Above ninety percent of beneficiaries completed the exit interviews (response rate: 95%). More than two-thirds (72%) of the respondents were females and aged >45 years (71%). Of all respondents, the majority were Hindu (89%), belonging to socially disadvantaged groups (80%), and illiterate (56%). Nearly all (95%) program beneficiaries found mobile health services easily accessible and building their knowledge and awareness (94%) on key health issues. Ninety-five percent of the program beneficiaries strongly favoured recommending the use of mobile health services to others. The overall satisfaction rate was 95% (Cronbach alpha 0.925).Conclusions: Mobile health services in rural areas are effective in meeting the beneficiaries’ expectations. High beneficiary satisfaction and trust in mobile health services strongly favours such services in other rural geographies.

Supervision of community health nurses in Ghana: a mixed-methods study on experiences and mentorship needs.

Adequate supervision is critical to maintain the performance of health workers who provide essential maternal and child health services in low-resource areas. Supportive supervision emphasizing problem-solving, skill development and mentorship has been shown to improve the motivation and effectiveness of health workers, especially at the community level, but it is not always routinely provided. Previous studies have assessed the uptake of supportive supervision among volunteer health workers and paid health centre staff, but less is known about the supervision experiences of paid community-based staff, such as community health nurses (CHNs) in Ghana. This mixed-methods study explores the frequency and content of CHN supervision in five districts in the Greater Accra and Volta regions of Ghana. We analysed quantitative data from 197 satisfaction surveys and qualitative data from 29 in-depth interviews (IDIs) and four focus group discussions (FGDs) with CHNs. While the majority of CHNs received supervision at least monthly, they reported that supervision was primarily focused on meeting clinical targets (48%) rather than on handling specific cases or patients (23%). Over a third (34%) of CHNs did not agree that supervisors help them with job-related challenges and nearly half (43%) were unsatisfied with their jobs. When asked about their mentorship needs, CHNs reported wanting feedback on how to improve their job performance (40%) and encouragement (30%). There were only slight variations in the frequency and content of supervision based on type of supervisor. During IDIs and FGDs, CHNs offered ideas for how to improve supervision, including more frequent field visits so that supervisors could see the on-the-ground realities of their work, greater respect and positive reinforcement. Overall, CHN motivation and job satisfaction may be strengthened by aligning supervision more closely with the principles of supportive supervision.

Factors influencing the gender gap in poverty: the Indonesian case

Indonesia reduced its poverty rate to a historical level of below 10%. Nevertheless, nearly 20% of the population remains vulnerable to falling into poverty. This study employs the Equally Distributed Equivalent (EDE) model finding that chronic poverty accounted for 69% while transient poverty accounted for the 30% in 2010. Access to credit, education level, and poor access to health services, influences the likelihood of chronic and transient poverty. Women face higher probabilities of remaining poor (chronic) or of falling into poverty (transitory) than men, due to a lack of access to health services and education. Women in urban areas are more likely to fall into transient poverty than men. Health and education services in rural areas are more urgently needed than in cities, as poverty is more highly associated with rural areas than in urban environments. Having larger families could increase the likelihood of chronic and transient poverty.

Geographic Disparities of Comorbidities in Mortality of Patients With Alzheimer’s Disease

Comorbidities can contribute to the gap in Alzheimer’s disease (AD) mortality between the East and West coast U.S. Using Multiple-Cause-of-Death and 5%-Medicare data, we analyzed age-adjusted (65+) mortality rates from AD in two Health and Human Services (HHS) areas with opposed mortality patterns in 2010-2018: 150.9±0.6/100,000 in HHS2 (NJ,NY) and 363.1±1.5/100,000 in HHS10 (AK,ID,OR,WA). Co-existing diabetes, heart failure, cerebrovascular, digestive, and kidney diseases significantly contributed to this gap, while contribution of heart diseases reduced its magnitude. An unexpectedly strong effect (higher rate in HH10 by a factor of 3-5) was identified for symptoms/signs that are not from identified specific diseases, life-threatening injures/falls and other external causes that are common among patients with AD. We concluded that although contributions of comorbidities with well-developed treatment guidelines (e.g., heart disease) to geographic disparities in AD mortality were small, the disparities can be generated by unexpected comorbidities including diseases with poorly defined conditions.

Who Will Care for the Medical Professionals?

Who Will Care for the Medical Professionals?

Postneonatal under-5 mortality in peri-urban and rural Eastern Uganda, 2005–2015

IntroductionCommunity and individual sociodemographic characteristics play an important role in child survival. However, a question remains how urbanisation and demographic changes in sub-Saharan Africa affect community-level determinants for child survival.MethodsLongitudinal...

Autonomy of patients in emergency services in the border area: A phenomenology study

Abstract The absence of hospitals is one of the problems that arise in health services in remote areas. To get further medical care, patients must be referred outside the island. The purpose of this study was to reveal the situation and experience of patients in emergency treatment in border and coastal areas in North Kalimantan. This study was designed with a qualitative method and a descriptive phenomenological approach was used. It involved 10 participants who lived on Sebatik island with the criteria of having experience with emergency cases and being referred out of the island. Data analysis was performed using a thematic analysis of Braun and Clarke (2006). Three themes emerged from this study: inappropriate emergency actions, patients’ choice of using the right to be referred, and assistance in challenging referrals. It was revealed that emergency management was not maximal due to the limitations of health workers and service facilities. Patients chose the right to be referred to as an effort to get better health services.

Intelligent Health Services Based on Biomedical Smart Sensors

Health services can be improved by means of intelligent techniques that handle efficiently massive volumes of data collected from biomedical variables. Nowadays, these services are not only oriented to disease diagnosis and prevention, but wellness too. Advanced technologies and last trends in computing, internet of things, sensors, and data science are driving the development of new systems and applications in the area of intelligent health services based on biomedical smart sensors that deserve to be known. Through five research articles and a review, this Special Issue provides the opportunity to obtain a representative view of the potential of these technologies when applied to such a human welfare-oriented area.