Model Of Health Services Utilization Research Articles

Understanding adherence to continuous positive airway pressure in patients with obstructive sleep apnea post-stroke: A prospective study based on the Andersen model.

Adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) post-stroke is often problematic, despite potential benefits. This study aimed to evaluate CPAP adherence in patients with OSA post-stroke based on the Andersen behavioral model of health services utilization. A total of 227 eligible participants were recruited from a Chinese hospital. After baseline assessment, participants were followed for 6 months to determine short-term CPAP adherence. Those with good short-term adherence were followed for an additional 6 months to explore long-term adherence and influencing factors. Short-term CPAP adherence rate was 33%. Being married or living with a partner, having an associate degree or baccalaureate degree or higher, and stronger health beliefs independently predicted short-term CPAP adherence. Only 25% of participants from the adherent group showed good long-term adherence. The factor associated with long-term CPAP adherence was participants not using alcohol. Adherence to CPAP is suboptimal among patients having OSA post-stroke. Addressing unfavorable predisposing factors and modifying health beliefs are suggested.

Barriers to mental health service utilization among African immigrants in the United Kingdom: A systematic review

AbstractBackgroundAfrican immigrants in the United Kingdom (UK) face unique challenges in accessing mental health services (MHSs), in contrast to their peers born in the UK, contributing to their worsening mental and physical health outcomes. This study aims to uncover barriers to MHS utilization and proffer evidence‐based recommendations toward addressing the mental health needs of African immigrants residing in the UK.MethodsA systematic literature search was conducted across six databases: Medline, PsycINFO, Web of Science, CIHNAL, Scopus, and Embase published up to September 2022. To assess methodological quality of the included studies, the Critical Appraisal Skills Program qualitative checklist and the Mixed Methods Appraisal Tool Version 2018 were used. Consecutively, a deductive thematic analysis was employed to group related barriers within overarching themes.ResultsThe study selection process yielded eight studies conducted in the UK, encompassing African populations identifying as African/Afro‐Caribbean origin, Somali refugees, and ethnic minorities of Black/British descent. The findings highlight the complex interplay of key barriers such as stigma, residential instability, cultural influences, discrimination, and accessibility issues, among others, that continue to hinder African populations from accessing and utilizing MHSs. These barriers were categorized into predisposing,enabling and need factors (themes), aligning with Anderson's model of health service utilization, reflecting a comprehensive range of challenges affecting this population.ConclusionThis systematic review illuminates the myriad barriers faced by African immigrants in utilizing MHSs in the UK, underlining the urgent need for targeted interventions. The findings advocate for the development of culturally sensitive, affordable, and accessible MHSs and policies that address the personal, sociocultural, and structural barriers identified. Collaboration across key stakeholders is highly recommended for advancing equitable and inclusive MHSs for all.

Utilization of Sexual Reproductive Health Services Among Youths in Malaysia: A Cross-Sectional Study Applying Andersen's Behavioral Model of Healthcare Utilization.

Background The sexual well-being of youths is crucial as it establishes the foundation for their sexual health throughout their lives. Malaysia's Ministry of Health (MOH) mainly delivers sexual reproductive health (SRH) services. Besides MOH, the National Population Family Development Board (NPFDB), under the purview of the Ministry of Women, Family and Community Development and Federation of Reproductive Health Association Malaysia, works closely with MOH to ensure the delivery of SRH information and services. Despite the availability of SRH services in Malaysia, it is uncertain whether youths are aware of and utilize these services. This study aims to identify factors that affect the utilization of SRH services among youths aged 18-24 years in Malaysia. Methodology This web-based, cross-sectional study was conducted from March 2022 to June 2022 using a self-administered pre-tested questionnaire. Andersen's Behavioral Model of Health Service Utilization was used to identify the variables included in the survey. Bivariate and multivariate logistic regression models were used to determine factors significantly associated with the utilization of SRH services. Adjusted odds ratio (AOR) and 95% confidence interval (CI) with a p-value <0.05 were considered to denote statistical significance. Results A total of 617 youths aged 18-24 years participated in the survey. Only 20.4% (n = 126) of youths had visited SRH services in their entire life, and only 8.4% (n = 52) of youths had visited SRH services in the past year. Predisposing factors such as age, marital status, exposure to SRH information from family and governmental agencies such as the NPFDB, enabling factors such as availability and comfort of SRH services, and need factors such as youths diagnosed with SRH-related diseases were significantly associated with SRH utilization. The older age group (20-24 years old) was more likely to utilize SRH services compared to the 18-19-year age group (AOR = 1.634, 95% CI = 1.041, 2.564, p = 0.033). Married participants were three times more likely to utilize SRH services than single participants (AOR = 2.910, 95% CI = 1.356, 6.249, p = 0.006). Participants who vaped had more odds of utilizing SRH services (AOR = 1.793, 95% CI = 1.014, 3.174, p = 0.045) The group of participants exposed to information on SRH from family had more odds of utilizing SRH service than those who did not receive information on SRH from the family (AOR = 1.964, 95% CI = 1.229, 3.138, p = 0.005). Likewise, participants who received SRH information from governmental agencies were more likely to utilize SRH services (AOR = 1.929, 95% CI = 1.202, 3.095, p = 0.006). Enabling factors that were associated with SRH utilization were the availability of services, described as self-buying medicine in pharmacies (AOR = 1.830, 95% CI = 1.184, 2.855, p = 0.007), and the comfortability of services (AOR = 1.928, 95% CI = 1.250, 2.974, p = 0.003). Youths who were diagnosed with SRH diseases (need factor) were four times more likely to utilize SRH services (AOR = 4.490, 95% CI = 1.935, 10.410, p < 0.001). Conclusions There is generally poor SRH service utilization and awareness among youths in Malaysia, which could be improved. The findings of this study can be used to influence SRH providers to offer a more age-targeted awareness program to meet the various SRH needs of youths.

"Nobody Wants to Have Conversation About HIV." A Thematic Analysis of in-Depth Interviews With Black Adolescent Women and Providers About Strategies for Discussing Sexual Health and HIV Prevention.

Black adolescent girls and young women (AGYW) in the US Southeast are disproportionately burdened by HIV. Infrequent assessment of sexual health in clinical encounters may contribute to low preexposure prophylaxis uptake for this population. This study explores Black AGYW and providers' perspectives on engaging in discussions about sexual health, including preexposure prophylaxis. In-depth interviews (IDIs) were conducted with Black AGYW aged 14 to 24 years and health care providers (MD, DO, NP, PA) who self-reported caring for Black AGYWs in Alabama. In-depth interviews were grounded in Andersen's Behavioral Model of Health Service Utilization to explore barriers and facilitators to sexual health discussions. After separate analyses, AGYW and provider IDIs were aggregated and reanalyzed using thematic analysis to identify themes related to their views on ways to improve Black AGYW engagement in sexual health discussions while in clinical settings. Twelve Black AGYW and 11 providers completed IDIs. Client median age was 21 years, representing 9 Alabama counties. Providers were predominately non-Hispanic White (82%), female (73%), and physicians (64%). Themes about ways to improve sexual health discussions included the following: (1) improve sexual health education for providers and adolescents, (2) normalize conversations in clinical settings, and (3) engage communities to continue these conversations outside of clinical settings. Sexual health and HIV prevention discussions with Black AGYW are not occurring. This study is one of the first to identify and highlight Black AGYW and provider-identified shared strategies for improving these discussions. Operationalizing these strategies is crucial to facilitating these discussions.

Female adolescent sexual reproductive health service utilization concerns: A qualitative enquiry in the Tema metropolis of Ghana.

Evidence globally indicates that female adolescents face numerous sexual and reproductive health (SRH) risks. Utilization of sexual reproductive health services among adolescents is of global health importance and plays a crucial role in adolescent sexual reproductive health outcomes and their quality of life. The current study explored sexual reproductive health service utilization concerns among female adolescents in the Tema Metropolis in Southern Ghana using the Anderson and Newman Behavioural model of Health Service Utilization as a guiding framework. The study utilized a qualitative exploratory descriptive design. Purposive sampling was used to recruit female adolescents. In-depth face-to-face interviews were conducted using a semi-structured interview guide. In all, 12 interviews were conducted. Each interview lasted between 45 and 60 minutes. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. Thematic analysis was guided by the constructs of the Anderson and Newman Behavioural model of health service utilization. Utilization of sexual reproductive health services among female adolescents is low in the Tema metropolis. Factors such as unprotected non-consensual sexual activity or an unwanted pregnancy sometimes triggered the use of these services. Barriers to utilization identified include lack of awareness on sexual reproductive health services, unreliable sources of SRH information, underestimation of the severity of sexual reproductive health problems faced, unmet expectations and poor experiences with service providers. The current study identified poor utilization of sexual reproductive health services among female adolescents within the Tema metropolis of Ghana. There is the need to increase the number of adolescent health corners, increase awareness about SRH services among adolescents, improve parent-child SRH communication and provide adequate training for healthcare providers to improve provider attitude towards adolescent SRH service delivery in order to increase utilization of sexual reproductive health services among female adolescents in the Metropolis.

Barriers and facilitators to accessing adolescents' mental health services in Karachi: users and providers perspectives.

Adolescents' Mental Healthcare (MHC) is influenced by numerous factors, and adolescents occasionally seek professional help for mental health (MH) issues. These factors become more complex within low-middle-income countries (LMICs); therefore, this study aims to understand barriers and facilitators to access mental health services among adolescents aged 10 to 19 years old from the perspective of users (parents) and providers (Mental Healthcare Providers - MHPs). Using a qualitative exploratory design, a semi-structured interview guide was developed using Andersen's health service utilization model. In-depth interviews were conducted with MHPs (n = 21) and parents of adolescents (n = 19) in the psychiatry department of public and private hospitals in Karachi, from October-December 2021. Data was thematically analyzed using an inductive approach. The findings revealed a consensus of users and providers in all three categories of the Andersen model and referred the compulsion as the major driving force to MHC access and utilization rather than personal choices. Within pre-disposing, need, and enabling factors; the participants highlighted a unique perspective; users regarded frequent migration, daily wage loss, and women's societal status as barriers while the need for marriage and patient willingness were stated as facilitators. Whereas, MHPs indicated societal tolerance, the burden on the health system, and the absence of Child and Adolescent Mental Health (CAMH) services as major gaps in service delivery. Service utilization is mainly facilitated by the severity of illness rather than healthy choices and beliefs, and accessibility and affordability. It is therefore imperative to prioritize adolescent MH through promotion and prevention approaches and address service delivery gaps to prevent treatment delays via task-shifting and capacity building of the health workforce.

Factors in Immigrant Children's Use of Physician and Dentist Visits, Hospital Care, and Prescribed Medication in the United States.

Applying the behavioral model of health services utilization to data from the United States, this study examined immigrant children's use of physician and dentist visits, hospital care, and prescribed medication. We employed data describing 9759 immigrant parents and children who participated in 2021's National Survey of Children's Health. Logistic regression results negatively linked physician visits to child health, child age, Asian children, fathers, lower parent education, lower family income, uninsured children, and parent's U.S. residence under 5 years. Dentist visits were positively associated with child age, girls, Hispanic children, parent education, family income, public/private health insurance coverage, and U.S.-born children, but such use was associated negatively with Asian children. Hospital use was positively associated with poor child health, Black children, children of "other" race/ethnicity, younger parent age, enrolled in health insurance, and parent's U.S. residence under 5 years. The use of prescribed medication was negatively associated with Asian children, younger child age, lower parent education, uninsured child, and lack of English proficiency. The paper's conclusion suggests policymakers expand Medicaid and CHIP eligibility among immigrant children and suggests community education to foster awareness of children's physical and oral health needs and of Medicaid, CHIP, and prescription assistance programs. The conclusion calls for healthcare providers and social workers to accommodate and respect immigrants' traditional health-related beliefs, showing cultural competence.

Self-reported barriers to screening breast MRI among women at high risk for breast cancer.

Annual screening breast MRI is recommended for women at high (≥ 20% lifetime) breast cancer risk, but is underutilized. Guided by the Health Services Utilization Model (HSUM), we assessed factors associated with screening breast MRI among high-risk women. From August 2020-January 2021, we recruited an online convenience sample of high-risk women ages 25-85 (N = 232). High-risk was defined as: pathogenic genetic mutation in self or first-degree relative; history of lobular carcinoma in situ; history of thoracic radiation; or estimated lifetime risk ≥ 20%. Participants self-reported predisposing factors (breast cancer knowledge, health locus of control), enabling factors (health insurance type, social support), need factors (perceived risk, screening-supportive social norms, provider recommendation), and prior receipt of screening breast MRI. Multivariable logistic regression analysis with backward selection identified HSUM factors associated with receipt of screening breast MRI. About half (51%) of participants had received a provider recommendation for screening breast MRI; only 32% had ever received a breast MRI. Breast cancer knowledge (OR = 1.15, 95% CI = 1.04-1.27) and screening-supportive social norms (OR = 2.21, 95% CI = 1.64-2.97) were positively related to breast MRI receipt. No other HSUM variables were associated with breast MRI receipt (all p's > 0.1). High-risk women reported low uptake of screening breast MRI, indicating a gap in guideline-concordant care. Breast cancer knowledge and screening-supportive social norms are two key areas to target in future interventions. Data were collected during the COVID-19 pandemic and generalizability of results is unclear. Future studies with larger, more heterogeneous samples are needed to replicate these findings.

Cost-related avoidance of oral health service utilization among lesbian, gay, and bisexual individuals in Canada.

This study estimates the frequency of cost-related oral health service avoidance (CROHSA) among lesbian, gay, and bisexual (LGB) individuals in Canada relative to heterosexual persons. Heterosexual and sexual minority individuals in Canada were compared using the national probability-based Canadian Community Health Survey 2017-2018. Logistic regression was used to quantify associations between LGB status and CROHSA. Mediators were tested following Andersen's behavioral model of health service utilization and included partnership status, oral health status, presence of dental pain, educational attainment, insurance status, smoking status, general health status, and personal income. From our sample of 103,216 individuals, 34.8% of LGB individuals reported avoiding oral health care due to cost compared to 22.7% of heterosexual persons. Disparities were most pronounced among bisexual individuals (odds ratio [OR] 2.29 95% confidence interval [CI] 1.42, 3.49). Disparities persisted despite adjustment for confounding using age, gender/sex, and ethnicity (OR 2.23 95% CI 1.42, 3.49). Disparities were fully mediated by eight hypothesized mediators namely, educational attainment, smoking status, partnership status, income, insurance status, oral health status, and the presence of dental pain (OR 1.69 95% CI 0.94, 3.03). In contrast, lesbian/gay individuals did not have elevated odds of experiencing CROHSA compared to heterosexual individuals (OR 1.27 95% CI 0.84, 1.92). CROHSA is elevated for bisexual individuals relative to heterosexual individuals. Targeted interventions should be explored to improve oral healthcare access among this population. Future research should assess the role of minority stress and social safety on oral health inequities among sexual minority groups.

Exploring the importance of predisposing, enabling, and need factors for promoting Veteran engagement in mental health therapy for post-traumatic stress: a multiple methods study

PurposeThis study explored Veteran and family member perspectives on factors that drive post-traumatic stress disorder (PTSD) therapy engagement within constructs of the Andersen model of behavioral health service utilization. Despite efforts by the Department of Veterans Affairs (VA) to increase mental health care access, the proportion of Veterans with PTSD who engage in PTSD therapy remains low. Support for therapy from family members and friends could improve Veteran therapy use.MethodsWe applied a multiple methods approach using data from VA administrative data and semi-structured individual interviews with Veterans and their support partners who applied to the VA Caregiver Support Program. We integrated findings from a machine learning analysis of quantitative data with findings from a qualitative analysis of the semi-structured interviews.ResultsIn quantitative models, Veteran medical need for health care use most influenced treatment initiation and retention. However, qualitative data suggested mental health symptoms combined with positive Veteran and support partner treatment attitudes motivated treatment engagement. Veterans indicated their motivation to seek treatment increased when family members perceived treatment to be of high value. Veterans who experienced poor continuity of VA care, group, and virtual treatment modalities expressed less care satisfaction. Prior marital therapy use emerged as a potentially new facilitator of PTSD treatment engagement that warrants more exploration.ConclusionsOur multiple methods findings represent Veteran and support partner perspectives and show that amid Veteran and organizational barriers to care, attitudes and support of family members and friends still matter. Family-oriented services and intervention could be a gateway to increase Veteran PTSD therapy engagement.

Assessment of Factors Influencing Utilization of Maternal and Child Health Services in The Federal Capital Territory (FCT), Abuja, Nigeria

Background: Although Nigeria has made progress in attaining the third sustainable development goal, maternal and child mortality remains a challenge to attaining universal health coverage. Utilization of maternal and child health services (MCH) is not uniform in the country, with the southern region outperforming the northern region, and within the northern region, the north central is outperforming the North West and east. Even in the north central, majority of state lag behind the federal capital territory (FCT), Abuja, in the uptake of MCH services. This study aimed to understand the determinants of maternal and child health service uptake in FCT. The evidence generated should help expand MCH services delivery in the FCT and other similar settings in Nigeria and beyond. Methodology: The research adopted a cross-sectional, mixed methods design in Bwari and Kuje Area Councils of Abuja, using a synthesis of the Ensor and Cooper demand and supply paradigm of health service uptake and the Andersen and Newman Behavioural Model for health service utilization. Qualitative data was obtained through Key Informant Interviews, In-Depth Interviews, and Focus group discussions with parents of under-five year children, pregnant women, health workers, program managers and community leaders. Quantitative data was collected through a household survey of women of childbearing age, using modified WHO Health Access and Use household survey questionnaire. Thematic analysis of the qualitative data was done to determine patterns relevant study objectives using Dedoose software. Quantitative analysis involved univariate descriptive analysis of respondents’ socio-demographics and multivariate logistic regression to determine the predictive value and relative importance of the predisposing, enabling, and needs determinants of MCH uptake. Result: Factors that favoured the uptake of MCH services included service availability, affordable cost of care, accessibility and proximity of health facilities, and perceived good knowledge and capacity of health workers. No religious or cultural barrier to MCH service uptake was reported. Education and employment status were statistically significant determinants of ANC uptake. Religion, level of education, and employment were statistically significant predisposing determinants of having skilled birth attendance (SBA). Also, employment and educational status were statistically significant predisposing factors of immunization uptake. Financial barriers, poor knowledge of availability services, previous negative experience with service utilization, poor perception on the value of MCH services were factors limiting uptake of MCH services. Conclusion: The study concludes that both demand and supply determinants of MCH services utilization were functionally demonstrated in the study area. However, the lack of health insurance scheme is a key limitation for universal coverage of MCH services in the study area. We recommend continuous improvement in health facility infrastructure and human resources capacity building by public authorities, to sustain and improve the current level of MCHs services delivery in the area. Furthermore, government should scale up the roll out of its national health insurance scheme to cover more enrollees.

The influence of demographic, health and psychosocial factors on patient uptake of the English NHS diabetes prevention programme

BackgroundThe prevention of type 2 diabetes (T2DM) is a major concern for health services around the world. The English NHS Diabetes Prevention Programme (NHS-DPP) offers a group face-to-face behaviour change intervention, based around exercise and diet, to adults with non-diabetic hyperglycaemia (NDH), referred from primary care. Previous analysis of the first 100,000 referrals revealed just over half of those referred to the NHS-DPP took up a place. This study aimed to identify the demographic, health and psychosocial factors associated with NHS-DPP uptake to help inform the development of interventions to improve uptake and address inequities between population groups.MethodsDrawing on the Behavioral Model of Health Services Utilization we developed a survey questionnaire to collect data on a wide range of demographic, health and psychosocial factors that might influence uptake of the NHS-DPP. We distributed this questionnaire to a cross-sectional random sample of 597 patients referred to the NHS-DPP across 17 general practices, chosen for variation. Multivariable regression analysis was used to identify factors associated with NHS-DPP uptake.Results325 out of 597 questionnaires were completed (54%). Only a third of responders took up the offer of a place. The best performing model for uptake (AUC = 0.78) consisted of four factors: older age; beliefs concerning personal vulnerability to T2DM; self-efficacy for reducing T2DM risk; and the efficacy of the NHS-DPP. After accounting for these, demographic and health-related factors played only a minor role.ConclusionUnlike fixed demographic characteristics, psychosocial perceptions may be amenable to change. NHS-DPP uptake rates may be improved by targeting the beliefs of patients about their risk of developing T2DM, their ability to carry out and sustain behaviours to reduce this risk, and the efficacy of the NHS-DPP in providing the necessary understanding and skills required. The recently introduced digital version of the NHS DPP could help address the even lower uptake amongst younger adults. Such changes could facilitate proportional access from across different demographic strata.

Disparities in Medicare beneficiaries' receiving medication synchronization.

Medication synchronization (med-sync) aligns patients' monthly or quarterly chronic medications to a predetermined single pickup date at a community pharmacy. The study objective was to examine med-sync enrollment disparities based on Medicare beneficiaries' predisposing, enabling, and need characteristics. This was a retrospective cohort study using a Medicare dataset of beneficiaries receiving medications from pharmacies that self-identified as providing med-sync. Medicare beneficiaries who were continuously enrolled in fee-for-service medical and pharmacy benefits during the study period (2014-2016) were included. Study cohorts (med-sync and non-med-sync patients) were defined, and bivariate and multivariable logistic regression analyses were performed. Andersen's Health Services Utilization Model guided our inclusion of predisposing, enabling, and need characteristics to examine for association with med-sync enrollment. A total of 170,180 beneficiaries were included, of which 13,193 comprised the med-sync cohort and 156,987 comprised the non-med-sync cohort. Bivariate logistic regression analysis revealed statistically significant differences (P < 0.05) in cohorts based on age, geographic region, type of residence, number of unique chronic medications, comorbidities, outpatient visits, and inpatient hospitalizations. Beneficiaries had higher odds of being enrolled in med-sync with increasing age (adjusted odds ratio [AOR] 1.003 [95% CI 1.001-1.005]) and if they resided in the Northeast (AOR 1.094 [95% CI 1.018-1.175]), South (AOR 1.109 [95% CI 1.035-1.188]), and West (AOR 1.113 [95% CI 1.020-1.215]) than those in the Midwest. Beneficiaries residing in nonmetro areas had lower odds of enrollment (AOR 0.914 [95% CI 0.863-0.969]) than those in metro areas. Beneficiaries with previous fewer inpatient hospitalizations (AOR 0.945 [95% CI 0.914-0.977]) were more likely to be enrolled, and those with more outpatient visits (AOR 1.003 [95% CI 1.001-1.004]) were more likely to be enrolled. Those taking a higher number of oral chronic medications (AOR 1.005 [95% CI 1.002-1.008]) had greater odds of enrollment in med-sync. Med-sync program expansion opportunities exist to address potential enrollment disparities based on age, geographic region, metropolitan area, and prior health utilization. Further studies are needed to develop and examine strategies among pharmacies to improve med-sync enrollment outreach to these subgroups of patients.

Evaluation of status quo and determinants of catastrophic health expenditure among empty-nest elderly in China: evidence from the China health and retirement longitudinal survey (CHARLS).

The aging society and the empty nest of the elderly have become issues that cannot be ignored by the Chinese government. Not only does the physical function of the empty-nest elderly (ENE) decline, and the incidence and prevalence of chronic diseases increase significantly, but they are also more likely to have loneliness, low life satisfaction, mental health problems, and even a much greater possibility of suffering from depression than the nonempty-nest elderly, besides the possibility of catastrophic health expenditure (CHE) which is also greatly increased. This paper aims to evaluate the status quo of dilemma and determinants of a vast sample of subjects based on the national level. Data were obtained from the latest 2018's data of the China Health and Retirement Longitudinal Study (CHARLS). Under the guidance of Andersen's model of health services utilization, this study clarified the overall and different demographic characteristics and prevalence of CHE among ENE and further built the Logit and Tobit model to explore the determinants of CHE occurrence and its intensity. A total of 7,602 ENE were included in the analysis, and the overall incidence of CHE among them was 21.20%. Poor self-reported health status (OR=2.03, 95% CI: 1.71-2.35), suffering from three or more chronic diseases simultaneously (OR=1.79, 95% CI: 1.42-2.15), low life satisfaction (OR=1.44, 95% CI: 1.20-1.68) and advanced age played the leading role in accounting for its high risk, and its intensity increased 0.0311 (SE=0.005), 0.0234 (SE=0.007), and 0.0178 (SE=0.005), respectively. In contrast, the leading drop in the probability of CHE among ENE was those whose monthly income was over 20,000 CNY (OR=0.46, 95% CI: 0.38-0.55), whose intensity declined 0.0399 (SE=0.005), whose monthly income was between 2,000 and 20,000 CNY (OR=0.78, 95% CI: 0.66-0.90) and whose intensity declined 0.021 (SE=0.005), and who were married during the survey period (OR=0.82, 95% CI: 0.70-0.94). Simultaneously, rural ENE showed more vulnerability and higher risk of CHE when confronted with these factors compared with the urban ones. More attention should be paid for ENE in China. The priority, including the relevant health insurance or social security measurements, should be further strengthened.

Factors influencing utilization of communicable disease prevention and treatment education among the floating population: a cross-sectional study in China

BackgroundIn China, communicable diseases (CD) have a negative impact on public health and economic stability. The influx of migrants, who make up a substantial portion of China’s population and continue to rapidly expand, has seriously hampered CD prevention and control, needing special care. This study aimed to identify key factors influencing the utilization of CD prevention and treatment education (CDPTE) among the floating population. We are confident that the findings will highlight obstacles facing CDPTE among the migrants, and guide future development prevention, treatment of CD, and health education services.MethodsA sample of migrants aged 15 years and above in 32 provincial units nationwide in 2018 was recruited by stratified multi-stage proportional to population size sampling (PPS). A structured questionnaire survey was conducted via face-to-face interviews. Subsequently, the Anderson health service utilization model was used as the theoretical framework and SPSS 26.0 statistical software was applied to analyze the data. The statistical description of the current situation of CDPTE acceptance and the chi-square test were used to compare the differences in CDPTE acceptance by different characteristics. Multivariate logistic regression was used to analyze key factors affecting the use of CDPTE among migrants.ResultsA total of 40.1% of the recruited participants reported receiving education on CD prevention and treatment, primarily delivered through traditional transmission media. Multilevel logistic regression results revealed that male migrants, aged 30–49 years, unmarried, with higher educational attainment, an average monthly household income of CNY 7,500-9,999 (or US$1,176-1,568), working more than 40 h per week, flowing into the Central and Western regions, migrated in the province, self-rated health, contracted family doctors and those with health records were more likely to receive CDPTE (p < 0.05).ConclusionOur findings revealed unsatisfactory acceptance of education on CD prevention and treatment among migrants, implying that health education should be strengthened further. Publicity of relevant policies and works should be strengthened and specific interventions should be developed for key regions as well as vulnerable groups to enhance CDPTE. More financial support should also be provided to improve the quality of health education.

Utilization of Public Long-Term Care Services and Burden Alleviation of Service Recipients and Their Families: Home Care and Institutional Care for Older Adults in South Korea

South Korea launched national long-term care insurance in 2008, and about one in ten older adults currently receives public long-term care (LTC) services. However, little research using nationally representative data has examined the factors related to LTC services and burden alleviation. Using Andersen’s health service utilization model, this study aims to explore the factors associated with the utilization of LTC services (i.e., home care services and institutional care services) in South Korea. Further, the alleviation of the burden (i.e., emotional, financial, and physical) among the service recipients and their family members are studied. We performed logistic regressions using national data: the 2019 Long-Term Care Survey (N=3,601). The results showed that living in urban areas and having fewer mobility limitations were associated with higher emotional and physical burden alleviation of home care service users. Moreover, living in urban and having longer geographic distances from the families were associated with more elevated financial burden alleviation. In terms of institutional care services, when the service recipient had fewer children, more chronic diseases, and lived in urban areas, the financial burden alleviation was higher. Based on the findings, we discussed the policy implications of the factors related to service utilization which varied by service and burden types.

Health Need Factors Are the Key Drivers of Hospitalization among the Elderly Living Alone: An Analysis of Longitudinal Data.

Elderly people living alone are a large and growing proportion of the population of many developed economies. The elderly, particularly those living alone, are more likely to be hospitalized overnight, with consequent substantial health and financial costs. A widely used model of health service utilization is augmented with social issues that may specifically delineate some of the issues associated with living alone. A longitudinal survey of elderly (aged 65 and over) living alone in Australia with three time points over four years was analyzed using logistic regressions for overnight hospitalization. The main set of data (n = 672) had an average age of 75.91 years and was 70.2% female. The health need factors of self-rated general health and illness severity, along with comorbidity, were the key drivers of hospitalization. There were some individuals with prioritized access to hospitalization due to forms of health funding. The social issues did not independently stand out as drivers of overnight hospitalization, but the complexity of the inter-relationships between issues when studying the health of the elderly began to arise. The results enhance our understanding of health services utilization, within the context of a relatively universal health care system.

Patient delay and related influencing factors in Chinese women under 35 years diagnosed with cervical cancer: A cross-sectional study

ObjectivePatient delay was defined as an interval between the discovery of the initial symptoms and diagnosis, which was longer than 90 days. This study aimed to determine the patient delay rate and related factors in women with cervical cancer in Hunan province, South-Central China. MethodsA cross-sectional study was conducted among 140 women with cervical cancer aged < 35 years from October, 2019 to March, 2021. Assumptions in Andersen Behavioral Model of Health Services Utilization were used to measure the factors influencing patient delay. Logistic regression models were used to identify factors associated with patient delay. A P-value of < 5% was considered significant. ResultsA total of 57 (40.71%) young women with cervical cancer had patient delay, and the median delay time was 134 (90-375) days. Predisposing factors, such as religion, unemployment, health beliefs related to cancer screening, and a history of cervical cancer screening within 2 years or more (P ​< ​0.05), were associated with patient delay. Enabling factors, such as distance to the nearest medical facility and type of the nearest medical facility, were associated with a reduced likelihood of patient delay. With the need-for-care factor, young women who experienced vaginal pain after or during intercourse had a higher risk (adjusted odds ratio, 33.48; 95% confidence interval, 3.22–348.68, P ​= ​0.003) of patient delay. ConclusionsThese findings reinforce the need for programs to enhance knowledge and awareness about cervical cancer screening and the importance of early diagnosis in women to help eliminate cervical cancer in China by 2050.

Behavioral Risk Factor and Primary Healthcare Utilization in South Africa.

(1) Background: An effective and efficient primary healthcare service is one of the reforms designed to achieve universal healthcare coverage. The success of the reform however depends on the ability to identify factors that could undermine through avoidable use, the effectiveness of various deployed scarce resources. The prevalence of unhealthy lifestyle risk factors that have been identified as a critical public health issue, which stimulate vulnerability and mortality through the development of non-communicable diseases, also have implications for government health spending through healthcare utilization. (2) Objective: This study aims to investigate the effect of behavioral risk factors on primary healthcare utilization in South Africa. (3) Methods: Using the NIDS wave 4 data set and a binary logistic estimation technique, the study is premised on a modified Anderson model of health service utilization. (4) Results: The binary logistic regression estimation results clearly show the intercepting effect of smoking in public primary healthcare utilization. Equally, the effect of these lifestyle behavior risk factors on public PHC is evident in urban communities. (5) Conclusion: This study suggests that there is a need to intensify awareness on the health effect of smoking; strengthen and broaden law that bans smoking; and introduce the screening of smoking patients for recurring counselling sessions and intervention at primary healthcare facilities in the country's urban communities.

고혈압 환자의 미충족 의료 관련 요인

Objectives This study was conducted to examine the prevalence of unmet healthcare needs and to identify related factors in adults with hypertension. Methods This study was performed using the data from the eighth Korea National Health and Nutrition Examination Survey 2019. The participants included 1,416 people over the age of 19 with hypertension. The data was analyzed by logistic regression analysis using complex samples based on Andersen’s model of health services utilization. Results Unmet healthcare needs were experienced by 9.0% of adults with hypertension. The factors associated unmet healthcare needs of adults with hypertension were living alone, activity limitation, lower perceived health status, and lower health-related quality of life. Conclusions In order to effectively manage the symptoms and diseases of adults with hypertension, it is important to use the health service when it is needed. In particular, the development of education and intervention to prevent unmet healthcare needs should consider need factors.