Lack Of Transportation Research Articles

Perceived patient navigator services and characteristics to address barriers to linkage to hepatitis C care among people released from provincial prison in Quebec, Canada

BackgroundPatient navigation increases linkage to hepatitis C virus (HCV) care following release from prison; however, little is known about the services patient navigators should provide to maximize linkage to care. We aimed to identify perceived barriers and facilitators to linkage to HCV care post-release, and to determine patient navigator services and characteristics best suited to address barriers to linkage to care among people released from prison. MethodsTen semi-structured interviews were conducted with adult (age ≥ 18 years) men living with chronic HCV, released from the largest Quebec provincial prison, and linked to HCV care by a patient navigator. Interviews were guided by the Socio-Ecological Model (SEM) and aimed to explore the multi-level barriers and facilitators to linkage to HCV care post-release. Interviews were audio-recorded, transcribed, and analyzed using a deductive, thematic approach. ResultsThe median age of participants was 54 years. Barriers to linkage to HCV care included competing priorities post-release (e.g., substance use, mental health issues, unstable housing), stigma (related to HCV, injection drug use, and incarceration), and lack of transportation. Facilitators included social support, established relationships with existing healthcare providers, prior cure with direct-acting antivirals, and HCV-related health literacy and knowledge. Perceived essential patient navigator services to enhance linkage included pre-release discharge appointments, housing assistance, and facilitated transportation to HCV appointments. Ensuring a consistent, non-judgemental, and empathetic patient navigator were considered important characteristics; lived experiences of incarceration and/or HCV were not felt to be essential for a patient navigator. ConclusionsInterventions that seek to improve linkage to HCV care for people following release from prison should address many levels (individual, interpersonal, and policy) of the SEM. While people experience several competing priorities post-release, having an empathetic and consistent patient navigator, regardless of their lived experiences of HCV and/or incarceration, may improve linkage to HCV care post-release.

Service-policy gaps in the settlement journey of Arabic-speaking immigrant newcomer and refugee older adults in Edmonton, Canada.

Immigrant newcomers and refugees (INRs) are two migrant categories that experience consistent systemic barriers to settlement and integration in Canada as older adults. This paper explores the challenges experienced by Arabic-speaking INR older adults in Edmonton, Canada, during settlement and discusses policy and service implications. A qualitative description study using community-based participatory research principles was implemented to evaluate and support digital literacy in Arabic-speaking INR older adults. We included men and women aged 55 and older who identified as immigrants or refugees and spoke Arabic. Experiences of settlement challenges were consistently identified during data collection and engagement of INR older adult participants. A thematic sub-analysis of interviews with (10 individuals and one couple) of participants' narratives was completed in 2022 and was used to identify themes related to settlement barriers for this population. Two main themes were identified: (1) Limited English skills and digital literacy gaps create service barriers for INR older adults, and (2) Gaps in services and policies as basic needs remain unmet. We describe key challenges experienced by INR older adults, such as language barriers, precarious finances, poor access to health care services and lack of transportation and employment opportunities, which hinder successful integration into the new society. This study showcases the ongoing challenges with early settlement and integration that continue despite Canada's well-developed immigration settlement landscape. INR older adults often remain invisible in policy, and understanding their experiences is a first step to addressing their needs for resources that support healthy aging in the post-migration context.

The Role of Agricultural Technology in Attaining Food Security among Small Farmers in Char Area in Mymensingh District

Farmers in the char areas of Bangladesh are frequently affected by food insecurity due to their low engagement in modern agriculture such as less use of modern agricultural technology. This study evaluates the socio-demographic characteristics of the sample farmers to assess their nutritional status and the factors influencing char dwellers' dietary diversity. Survey data were collected from 70 households, and focus group discussions were conducted using a semi-structured questionnaire from Nilokhiya char under the Mymensingh District of Bangladesh. An OLS regression model was used to estimate the influence of socioeconomic characteristics of sample households on the decision on factors influencing dietary diversity. The farming type of the farmers is another concern of this study where results show that 90% of farmers in the char areas rely on rice and vegetable farming, whereas more than 60% of the farmers are also involved in livestock and poultry farming at the same time. The nutritional status of char farmers shows that their diet includes a variety of foods but is deficient insufficient protein and healthy fats, which could have an impact on their overall nutrition. Cereals are a staple in the diet, as indicated by the high consumption rate (97.1%) and the substantial average intake (2.30 kg/day). Every household consumes fruits, though in smaller quantities (0.28 kg/day). Eggs are less frequently consumed (57.1%) despite a higher intake (2.64 kg/day). Dietary diversity has a strong positive correlation with supply (.913) at a 1 % significant level which means that efficient supply chains minimize delays, reduce spoilage, and ensure a continuous flow of food to markets to ensure food security. A positive correlation with total income (.373) leads to a higher total income also supports greater dietary diversity. Credit was significant at a 5% level (.267) indicating that a 1 % increase in credit leads to an increase in dietary diversity by 267%. On the contrary, Experience has a negative relationship with dietary diversity which means that experience does not influence food security. Lack of transport and communication, environmental hazards, and natural disasters are the most significant problems faced by the farmers in the char area.

Challenges and coping strategies among caregivers of children with cancer receiving care at a national referral hospital in Kenya

BackgroundThe number of children diagnosed with cancer is expected to increase by 2050. The caring aspect of these children is usually left to members of the family, more so the mothers. Caregivers are usually faced with various challenges, such as financial issues, social stigma, and emotional and psychological issues. Caregivers use various coping strategies to manage the challenges they experience in the caring process, which can be positive or negative coping strategies.ObjectiveTo explore the challenges and coping strategies of caregivers of children with cancer receiving care at a national referral hospital in Kenya.MethodsThis study employed a descriptive phenomenological approach to explore the challenges and coping strategies of caregivers of children with cancer receiving treatment at a national referral hospital in Kenya. Purposive and snowball sampling techniques were used to select 44 participants for five focus group discussions (FGDs) conducted between October and December 2023. The data were analysed via inductive thematic analysis.ResultsFour themes arose from the challenges experienced, which included psychological, financial, treatment-related, and social/family-related issues. These eleven subthemes included stress, depression, lack of transport, lack of food, loss of employment, treatment delays, and marital issues, among others. Two themes related to coping strategies were positive adaptation and denial, which were highlighted as negative coping strategies. Positive coping included praying, crying, talking to people, and seeking help.ConclusionCaregivers of children with cancer undergo various challenges and apply various coping strategies to try and adapt to their new normal. Reinforcing positive coping strategies and helping caregivers utilize other coping strategies, such as the use of support groups, could help them better care for their children.

Experiences of rural poverty in Stratford district, Aotearoa New Zealand: A qualitative study with implications for rural social work

INTRODUCTION: People experiencing poverty who live in rural communities may have complex needs as rurality exacerbates their issues. Isolation, stigma, transport difficulties and a lack of services contribute to the challenges experienced by people living in rural communities who experience poverty. For social workers, responses need to be creative and flexible to counter the lack of services or people being unable to access services due to distance and/or a lack of transport. METHODS: I conducted semi-structured, in-depth interviews with 28 participants. Participants self-identified as experiencing poverty and ranged in age from teenagers to over 65s. Transcripts were analysed using applied thematic analysis. FINDINGS: Four themes were identified: stigma, isolation, transportation and access to services. Issues in these areas exacerbated participants’ experience of poverty. CONCLUSION: The findings of the study suggest that there is a significant advocacy role for social workers in rural communities regarding access to services and service development, transportation and challenging stigma to improve the lives of people living in rural communities who experience poverty. Further investigation is suggested to explore specific groups experiencing poverty in rural communities, particularly Māori, and to consider other marginalised identity groups and different geographical areas.

Modeling the critical causal factors of postharvest losses in the vegetable supply chain in eThekwini metropolitan municipality: The log-linear regression model

Vegetables, rich in essential bioactive compounds, are crucial for human health and vital to the global food system. However, the supply chain for vegetables is intricate, marked by product seasonality, demand variability, and limited shelf life. These factors contribute to significant losses, with 44 % of global vegetable production wasted at various stages in the food chain. Postharvest losses (PHLs) are a considerable issue, posing risks to food security and economic sustainability. Despite numerous interventions aimed at reducing PHLs, a comprehensive understanding of the primary causes remains insufficient, preventing the implementation of practical solutions. The study investigates the factors causing PHLs in the vegetable supply chain. A structured questionnaire was used to collect the data from 238 farmers. The study adopted a cross-sectional research design and a multi-stratified random sampling method. Descriptive statistics and log-linear regression were used to analyze the data. The results revealed that 56 % of the farmers were women, with an average age of 45 and a household size of five. Most farmers had completed 12 years of education, with 76 % being unemployed and 78 % depending on farming as their primary source of income. The regression analysis showed that age, distance to markets, and lack of transportation were significant factors at the 1 % level. In contrast, education, farming experience, market access, and weather conditions were significant at the 5 % level. The study recommends policies promoting innovative postharvest technologies alongside investment in infrastructure to mitigate these losses.

Circumstances leading to home childbirths among women living in Winterveldt, Tshwane Municipality of South Africa.

Childbirth complications, which may include maternal and perinatal mortality are common among women giving birth at home compared to those giving birth at health care facilities. Increasing access to childbirth in health care facilities improves the maternal and perinatal health outcomes for both the mother and child. There are however reported cases of home childbirth and decreasing numbers of health care facilities' births in developing countries. The researchers identified an increase in number of babies born before arrival in several health care facilities and therefore explored this phenomenon in order to understand circumstances leading to this practice. The findings of the study have a potential to inform interventions and strategies to strengthen community health education and engagement on maternal and child health issues. Information gathered through this study will also be important in informing decision making on prioritization of key interventions to incorporate Traditional Birth Attendants (TBAs) services in reproductive health care. An exploratory descriptive qualitative study was used to conduct in-depth interviews amongst women of childbearing age living in a semi urban area of the Tshwane municipality in South Africa. The sample of this study was made of 21 purposively selected women who had experienced home childbirth. Thematic content analysis was used for data analysis. Many women made a choice to give birth at home due to religious and cultural beliefs. However, some women wished to give birth in a health care facility but due to unintentional factors such as lack of transport, failure to identify labour pains, and fast labour; they ended up giving birth at home. Some of the women indicated harsh treatment in health care facilities compared to the pleasant birthing experience at home as reasons for opting for home childbirth.

Newborn Hearing Screening Success… Patient Care Failure.

To assess the efficacy of a newborn hearing screening program in an urban hospital 24 years after a longitudinal study identified failings in its program and recommended solutions. A hospital-specific, Pennsylvania database was queried to determine rates of in-hospital testing, referral, and diagnosis for Temple University Hospital (TUH), and to compare these with reporting sites statewide. At TUH, interviews with newborn hearing screeners and audiologists were conducted to identify barriers to care. In the year 2022, 2,006/2,069 newborns (97%) were successfully screened prior to hospital discharge at TUH. (63 babies were never tested). There were 73 who did not pass automated auditory brainstem response testing (ABR) in at least one ear. All of these 73 infants returned for repeat automated ABR testing and 50/73 passed in both ears. 23/2006 (1%) were referred to diagnostic testing. 13/23 were successfully scheduled. 11/23 passed in both ears. 2/13 were found to have hearing losses. 10 infants (43%) were lost to follow-up and were never diagnosed. Examining lost-to-follow-up rates statewide, we identified a relationship between successful follow-up and local median family income. Legislation on the state level and improvements in audiometric technology have led to highly successful in-hospital screening with relatively low false-positive rates. Despite this, inadequate outpatient follow-up testing and inequities in the American health care system continue to delay audiometric diagnosis and habilitation of congenital hearing loss. Lack of transportation, childcare for siblings, and newborn insurance status impede access to diagnostic testing. Level 3 evidence-retrospective review comparing cases and controls. Laryngoscope, 2024.

Harnessing the Power of Integrated Behavioral Health to Enhance Insomnia Intervention in Primary Care.

Insomnia is prevalent in primary care and associated with co-morbid physical and mental health conditions and poor health outcomes. While there are effective treatments for insomnia in specialty mental health care, many patients have difficulty accessing these interventions. To begin, patients do not always report their sleep challenges to physicians; meanwhile, primary care providers often do not screen for insomnia symptoms. Furthermore, patients may experience several barriers to accessing specialty care for insomnia treatment, such as a limited number of available providers, financial burden, lack of transportation, and low perceptions of treatment effectiveness. Primary care behavioral health (PCBH) is well-equipped to address the challenges of accessing evidence-based care for insomnia through (1) identifying sleep issues, (2) providing psychoeducation on the possible treatments for insomnia, (3) intervening with poor sleep habits and acute insomnia early to prevent chronic insomnia, and (4) delivering appropriate evidence-based interventions for chronic insomnia. Primary care clinics should leverage behavioral health providers to increase screening and embed interventions into routine care for the benefit of improved outcomes for patients with insomnia and other sleep challenges.

The Role of NGOS in Promoting Women Entrepreneurship in India

In recent times, the government has realized the importance of entrepreneurship as a prominent alternative to traditional wage employment in the new economy, and its role in increasing the pace of economic growth. Therefore, Indian government has come up with various special policy measures to help women entrepreneurs. there are major limitations among women entrepreneurs in accessing those facilities. These limitations arise due to various factors, such as: lack of awareness, lack of information, difficulty in accessibility of finance, lack of easy access of entrepreneurial training and post training support, lack of market and network support, lack of self-confidence and managerial skills, bureaucratic hassles, lack of transportation mainly in remote areas, restriction of government officials in terms of timing when women also have to perform household activities etc.

Inequities in Self-Reported Social Risk Factors by Sexual Orientation and Gender Identity

Sexual minority (ie, people who self-identify as gay, lesbian, bisexual, and other nonheterosexual identities) and gender minority (ie, people who self-identify as transgender, nonbinary, or other noncisgender identities) adults report worse health outcomes compared with heterosexual and cisgender adults, respectively. Although social risk factors (SRFs; eg, housing instability) are associated with health outcomes, little is known about the prevalence of SRFs among sexual and gender minority adults. To examine differences in the prevalence of SRFs by sexual orientation and gender identity among adults. This cross-sectional study used Behavioral Risk Factor Surveillance System data collected from January 2022 to February 2023 for adults aged 18 years or older residing in 22 US states. Self-reported sexual orientation and gender identity. Outcome measures were dissatisfaction with life, lack of emotional support, social isolation, employment loss in the past 12 months, Supplementary Nutrition Assistance Program participation in the past 12 months, insufficient food, inability to pay bills, inability to pay utilities, lack of transportation, and stress. Survey weights were applied. Multivariable linear regression models were used to measure the association between sexual orientation and gender identity for each outcome. The study sample comparing outcomes by sexual orientation included 178 803 individuals: 84 881 men (48.5%; 92.9% heterosexual; 7.1% sexual minority) and 93 922 women (51.5%; 89.4% heterosexual; 10.6% sexual minority). The study sample comparing outcomes by gender identity included 182 690 adults (99.2% cisgender; 0.8% gender minority). Of sexual minority women, 58.1% reported at least 1 SRF compared with 36.5% of heterosexual women. Sexual minority women were significantly more likely to report social isolation (difference, 7.4 percentage points [PP]; 95% CI, 4.9-10.0 PP) and stress (difference, 12.2 PP; 95% CI, 9.8-14.7 PP) compared with heterosexual women. A greater proportion of sexual minority men (51.1%) reported at least 1 SRF than heterosexual men (34.0%); the largest magnitudes of inequity were in dissatisfaction with life (difference, 7.9 PP; 95% CI, 5.8-10.1 PP) and stress (difference, 6.7 PP; 95% CI, 4.5-8.9 PP). Of gender minority adults, 64.1% reported at least 1 SRF compared with cisgender adults (37.1%). Gender minority adults were significantly more likely to report social isolation (difference, 14.8 PP; 95% CI, 9.9-19.7 PP) and stress (difference, 17.0 PP; 95% CI, 11.9-22.1 PP). In this cross-sectional study, sexual and gender minority adults were significantly more likely to report multiple SRFs. These findings suggest that policies and community-based systems to advance socioeconomic equity among sexual and gender minority adults are critical.

Academic Essay On Equitable Access To Mental Health Services In Brazil

Equitable access to mental health services in Brazil faces complex and interconnected challenges. Among the main issues are regional inequalities, socioeconomic barriers, and the stigma associated with mental disorders. Regional inequality results in significant differences in the quality and availability of mental health services between urban and rural areas. While large cities such as São Paulo and Rio de Janeiro have advanced infrastructure and qualified professionals, rural areas and urban outskirts suffer from a lack of resources and professionals, limiting access to necessary care. Socioeconomic barriers also play a crucial role. Low-income populations face additional difficulties, such as lack of transportation and inadequate health insurance, which restrict access to mental health services. The lack of information and the stigmatization of mental disorders worsen the situation, discouraging individuals from seeking treatment due to fear of discrimination and prejudice. To address these challenges, it is essential to adopt integrated strategies. Expanding mental health infrastructure in underserved areas and creating integrated care networks are fundamental. Public policies should reduce socioeconomic inequalities by providing financial support and improving transportation. Awareness campaigns about mental health can overcome informational barriers and stigma. Continuous training of health professionals and community participation are also crucial to ensure inclusive and locally adapted care. With a coordinated effort, it is possible to promote more just and comprehensive access to mental health services in Brazil.

Association of Intrinsic and Extrinsic Factors on Hearing Aid Servicing, Repair and Users’ Satisfaction During COVID-19 Pandemic

Purpose: Hearing aids (HAs) are electronic devices that provide amplification for individuals with hearing impairment. It requires good maintenance for its trouble-free function, but when HAs are not repaired or serviced on time, it affects communication. In the lockdown period during COVID-19 pandemic, many services were put on hold, including the HA service leading to poor user satisfaction. The study aimed to survey the HA user’s perspectives on its repair, servicing, and satisfaction during COVID-19 using a questionnaire.Methods: Sixty-seven participants reported to the organization during the COVID-19 pandemic for service and repair of HAs participated in the study. All the participants answered a questionnaire which consisted of different variables (extrinsic and intrinsic) affecting HA service, repair and satisfaction.Results: The chi-square test showed that extrinsic factors enjoyed relatively more (14) significant associations than intrinsic ones (8 associations). The lack of transport and non-availability of the HA centres were associated with the significant reason for the delay in the HA being brought for repair.Conclusions: The lockdown due to the COVID-19 pandemic had affected the service, repair and satisfaction of the HA users. The associations among the variables would make the service delivery better during any such pandemics.

“I Figured It Might Be Because We Are Rural”: A Qualitative Study of Barriers and Opportunities Related to Home-Based Personal Assistance Services

Personal care assistance (PCA) provides vital support so rural disabled people and older adults can live in their communities. Currently, the state of home and community-based services in the United States is dire, with major shortfalls in access and utilization of these services. Moreover, little is known about the experiences of people living in rural areas who need paid, in-home assistance with activities of daily living. Because rural areas are often underserved and under-resourced, this study aimed to understand the experiences of rural users of personal care assistance services to inform the development of a training for rural people. Between February and November of 2021, 38 semi-structured qualitative interviews were conducted with 40 self-identified rural-dwelling people across the United States who use paid PCAs. Interview topics included finding, hiring, and training workers; worker qualities; and how living in a rural place impacted PCA services. Using thematic coding, results highlight how rurality intersected with participants’ daily experiences. Respondents identified 3 barriers to getting PCA services: (1) lack of transportation and travel distance, (2) worker shortages, and (3) fewer local community services; and one facilitator of obtaining PCA services: strong community connection. Additionally, some aspects of rural culture—such as valuing a slower pace of life, independence, and rugged individualism—presented both barriers and opportunities for rural PCA recipients. As the home care worker shortage crisis in the United States is expected to worsen in coming decades, rural people needing PCA services face unique circumstances related to place and culture.

Investigating Rural Logistics and Transportation through the Lens of Quadruple Bottom Line Sustainability

Background: An alternative to unsustainable urban developments, rural living is on the rise, but it already has its challenges. To that end, rural logistics and transportation (RLT) calls for a comprehensive analysis of its context, especially in a climate-changed and socially turbulent world. Unlike urban logistics, there is limited focus on RLT in academic literature. However, rural areas’ lack of transportation and limited logistics operations negatively affect rural residents’ daily lives, especially socially disadvantaged groups such as older people, children, women, and low-income households. Methods: This study first identifies the key literature on RLT and sustainability using a systematic literature review. Then, it synthesizes from the extant literature the challenges in RLT and proposed solutions to understand how to improve accessibility and address some barriers to implementation, all through the perspective of quadruple bottom line (QBL) sustainability pillars. Results: The lack of opportunities presented to rural residents due to limited RLT leads to inequality between rural and urban populations, requiring academic attention. Moreover, despite the growing emphasis on sustainability in academic literature, there is a noticeable lack of attention to sustainability in RLT. Conclusions: This study leads policymakers toward a better understanding of rural communities’ complexities, directs practitioners to adopt the QBL perspective in decision-making, and aims to stipulate innovative RLT topics for further research for academicians.

AWARENESS ON MENTAL HEALTH AMONG THE STUDENTS OF HIGHER SECONDARY LEVEL: A STUDY

In formal educational system the most important stage of education is the secondary stage. Especially the higher secondary stage can be considered as the gateway of building a better career in the life of any student. All students of this stage feel pressure in their study for securing good marks in the exam. Moreover they feel anxiety as well as stress because of preparing themselves for entrance exams. Apart from these there are so many students which use to face several problems, like- poverty, lack of transportation, gender disparity, parent’s illiteracy, natural calamities and superstitions and so on. So it is very difficult to adjust with these kind of situations along with their heavy pressure of study. Sometime the students of secondary level cannot cope up with such type of overloaded situations. Therefore it is very important to keep their mental health in a sound position so that they can tackle their problems and perform their duties properly. They should know about their mental health problems and they should be aware about the importance of mental health. Especially the students of secondary level need to know the various means of development of their mental health. The present study is aimed at creating awareness about the need and importance of mental health among the students. The objectives are-1. To study the problems of mental health of the students. 2. To study the awareness towards mental health among the students. 3. To study the difference between boy and girl students in mental health awareness.

Navigating the Role of Mobile Audiology in Public Health: Overcoming Hearing Health Care Barriers That Impact the Underserved

Purpose: The purpose of this clinical focus article is to convey the significant role that mobile audiology could have in the public health space and discuss how mobile audiology can overcome obstacles that hinder access to traditional audiological care. This article also introduces strategies for delivering innovative audiological care. Method: The article is drawn from the authors' personal research, business, and clinical experiences. It describes the variations in mobile audiology that could aid in improving health care outcomes, identifying underserved areas, identifying barriers, implementing innovative solutions to overcome barriers, limitations of mobile audiology, and implications for optimized hearing health care. Conclusions: Mobile audiology services may play a vital role in public health programs and initiatives by bringing hearing health care to underserved communities, promoting accessibility, and addressing hearing health care concerns that disproportionately impact vulnerable populations. Mobile audiology services extend beyond the conventional concept of service delivery and can reduce barriers that prevent access to hearing health care, such as lack of transportation, geographical conditions/distance, time, lack of insurance coverage for evaluation/treatment, lack of qualified hearing health professionals, and financial constraints. Various services can be offered through mobile audiology, such as comprehensive screenings, diagnostic evaluations, and rehabilitation services/interventions. Mobile audiology services provide patients with the intervention necessary to improve communication abilities, quality of life, and overall health care outcomes.

Rural veteran perception of healthcare access in South Carolina and Florida: a qualitative study

BackgroundAccess to mental and physical healthcare in rural areas is challenging for Veterans and their families but essential for good health. Even though recent research has revealed some of the challenges rural Veterans face accessing healthcare, a complete understanding of the gap in access is still unclear.MethodsThis qualitative study aimed to explore participants’ perceptions of healthcare access. Structured interviews were conducted with 124 Veterans and spouses of Veterans from rural qualifying counties in South Carolina and Florida.ResultsThe study’s results revealed five main dimensions of access: geographic proximity, transportation, communication, cultural competence, and resources. Distance to service needed can negatively impact access for Veterans and their families in general, especially for those whose health is declining or who cannot drive because of their age. Lack of transportation, problems with transportation services, and lack of public transportation can lead to delays in care. Additionally, the lack of communication with the Veterans Affairs (VA) Health System and with the healthcare team, as well as inefficient communication among the healthcare team, lack of coordination of care between the VA health system and community providers, and the lack of cultural competence of healthcare providers and contracted personnel made access to services even more challenging.ConclusionsImproving communication can help to develop a sense of trust between Veterans and the VA, and between Veterans and spouses with the healthcare team. It can also lead to increased patient satisfaction. Ensuring healthcare providers and contracted personnel are culturally competent to talk and treat Veterans can improve patient trust and adherence to treatment. Lastly, resource-related challenges included financial problems, lack of prompt access to appointments, lack of providers, limited access to local clinics and hospitals, limited local programs available, and reimbursement issues.

Patient experiences of buprenorphine dispensing from a mobile medical unit

BackgroundOverdose deaths continue to rise within the United States, despite effective treatments such as buprenorphine and methadone for opioid use disorder (OUD). Mobile medical units with the ability to dispense buprenorphine have been developed to engage patients and eliminate barriers to accessing OUD treatment. This study reports survey responses of patients of a mobile medical unit dispensing buprenorphine in areas of Chicago, IL with high overdose rates.MethodsAll patients who were dispensed buprenorphine via the mobile medical unit were invited to participate in a 7-item anonymous survey between May 24, 2023, and August 25, 2023. The survey included 5-point satisfaction scale, multiple-choice, and open-ended questions. Outcomes included satisfaction with buprenorphine dispensing from the mobile medical unit, satisfaction with filling buprenorphine at a pharmacy in the past, barriers experienced at pharmacies when filling buprenorphine, and whether the client would have started treatment that day if the mobile medical unit had not been present. Satisfaction scale and multiple-choice question responses were assessed using descriptive statistics. Wilcoxon signed-rank test was used to compare median satisfaction levels between receiving buprenorphine from the mobile medical unit versus filling a buprenorphine prescription at a community pharmacy. Open-ended questions were analyzed qualitatively using inductive thematic analysis.Results106 unique patients were dispensed buprenorphine from the mobile unit during the study period. Of these patients, 54 (51%) completed the survey. Respondents reported high satisfaction with the buprenorphine dispensing process as a part of a mobile medical unit. Of those who had previously filled buprenorphine at a pharmacy, 83% reported at least one barrier, with delays in prescription dispensing from a community pharmacy, lack of transportation to/from the pharmacy, and opioid withdrawal symptoms being the most common barriers. 87% reported they would not have started buprenorphine that same day if the mobile medical unit had not been present. Nearly half of survey participants reported having taken buprenorphine that was not prescribed to them. Qualitative analysis of open-ended survey responses noted the importance of convenient accessibility, comprehensive care, and a non-judgmental environment.ConclusionsMobile medical units that dispense buprenorphine are an innovative model to reach patients with OUD who have significant treatment access barriers. This study found that patients who experienced barriers to accessing buprenorphine from a pharmacy were highly satisfied with the mobile medical unit’s buprenorphine dispensing process. Programs seeking to develop mobile buprenorphine dispensing programs should consider patient priorities of accessibility, comprehensive care, and welcoming, non-judgmental environments.

Contraceptive access and use before and during the COVID-19 pandemic: a mixed-methods study in South Africa and Zambia

Background The COVID-19 pandemic affected global access to health services, including contraception We sought to explore effects of the pandemic on family planning (FP) service provision and use in South Africa and Zambia, including on implant and intrauterine device (IUD) users’ desire and ability to obtain removal. Methods Between August 2020 and April 2021, we conducted surveys with 537 women participating in an ongoing longitudinal contraceptive continuation study. We also carried out in-depth interviews with 39 of the survey participants and 36 key informants involved in FP provision. We conducted descriptive analysis of survey responses and thematic analysis of interviews. Results Contraceptive use changed minimally in this sample with the emergence of COVID-19. Fewer than half of women (n=220) reported that they tried to access FP since the start of the pandemic. The vast majority of those seeking services were using short-acting methods and 95% were able to obtain their preferred method. The proportion of women not using a method before and after the start of the pandemic did not change in Zambia (31%), and increased from 8% to 10% in South Africa. Less than 7% of implant or IUD users in either country reported wanting removal. Among the 22 who sought removal, 10 in Zambia and 6 in South Africa successfully obtained removal. In qualitative interviews, those reporting challenges to service access specifically mentioned long queues, deprioritization of contraceptive services, lack of transportation, stock-outs, and fear of contracting COVID-19 at a facility. Key informants reported stock-outs, especially of injectables, and staff shortages as barriers. Conclusions We did not find a substantial impact of COVID-19 on contraceptive access and use among this sample; however, providers and others involved in service provision identified risks to continuity of care. As the COVID-19 pandemic wanes, it continues to be important to monitor people’s ability to access their preferred contraceptive methods.