Perceptions Of Access To Health Care Research Articles

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.

Experiencing COVID-19 on the spectrum: perceptions of healthcare access among autistic adults during a global pandemic and implications for social workers

ABSTRACT The novel coronavirus pandemic (COVID-19) required substantial changes in socialization to mitigate the spread of the virus. Stay-at-home and social distancing mandates required changes in work, school, and healthcare access for autistic adults. This qualitative online netnographic study utilized a public online forum to examine 1,102 posts detailing the experiences of COVID-19 by autistic adults from March 2020 to December 2020. We found two main themes related to seeking behavioral health services and seeking support related to service delays and barriers during the COVID-19 pandemic. Implications for social work practice and supporting autistic people in navigating healthcare access are discussed.

Validation of the Amharic version of perceived access to healthcare services for patients with cervical cancer in Ethiopia: A second-order confirmatory factor analysis.

Accessing healthcare services is a multifaceted phenomenon involving various elements, encompassing the demand, identification, reach, and utilization of healthcare needs. The literature offers methods for capturing patients' perceptions of healthcare access. However, to accurately measure patient perceptions, it is imperative to ensure the validity and reliability of such instruments by designing and implementing localized language versions. The primary aim of this study was to validate the Amharic version of the perceived access to health-care services among patients diagnosed with cervical cancer in Ethiopia. A cross-sectional study was conducted among cervical cancer patients at oncology centers in Addis Ababa, Ethiopia. A consecutive sampling approach was used and data collection took place from January 1 to March 30, 2023. Following initial validation and pretesting, a KoboCollect mobile phone application was employed for data collection. Subsequently, the collected data underwent cleaning in Microsoft Excel and analysis through Amos software v.26 and R programming. Various validity and reliability tests, such as content validity, convergent validity, face validity, divergent validity, known-group validity, and reliability tests, were executed. A second-order confirmatory factor analysis was developed to calculate incremental model fit indices, including CFI and TLI, along with absolute measures, namely SRMR and RMSEA. A total of 308 participants were involved in the study, with 202 (65.6%) being patients referred from outside Addis Ababa. The initial evaluation of content validity by expert panels indicated that all criteria were met, with a CVR range of 0.5 to 1, I-CVI values ranging from 0.75 to 1, an S-CVI value of 0.91, and face validity values ranging from 2.4 to 4.8. The internal consistency of items within the final constructs varied from 0.76 to 0.93. Convergent, known-group, and most divergent validity tests fell within acceptable fit ranges. Common incremental fit measures for CFI and TLI were achieved with corresponding values of 0.95 and 0.94, respectively. The absolute fit measures of SRMR and RMSEA were 0.04 and 0.07, indicating good and moderate fit, respectively. The study indicated a high internal consistency and validity of items with good fit to the data, suggesting potential accuracy of the domains. A five-domain structure was developed which enables adequate assessment of perceived access to health-care services of patients with cervical cancer in Ethiopia. We suggest that the tool can be utilized in other patient populations with a consideration of additional constructs, such as geographic accessibility.

Describing Perspectives of Telehealth and the Impact on Equity in Access to Health Care from Community and Provider Perspectives: A Multimethod Analysis.

Introduction: The rapid adoption of telehealth as a result of the COVID-19 pandemic provided the opportunity to examine perceptions of health care access and use of telehealth for delivery of effective and equitable care in low-income and historically marginalized communities. Methods: Focusing on communities with high social vulnerability, a multimethod analysis of combined perspectives, collected February through August 2022 from 112 health care providers, obtained from surveys and interviews, and 23 community members via 3 focus groups on access to care and telehealth. Qualitative data were analyzed using the Health Equity and Implementation Framework to identify barriers, facilitators, and recommendations for the implementation of telehealth using a health equity lens. Results: Participants perceived that telehealth helped maintain access to health care during the pandemic by addressing barriers including provider shortages, transportation concerns, and scheduling conflicts. Additional benefits suggested were improved care quality and coordination attributed to convenient avenues for care delivery and communication among providers and patients. However, many barriers to telehealth were reported and considered to limit equitable access to care. These included restrictive or changing policies regarding allowable services provided via telehealth, and availability of technology and broadband services to enable telehealth visits. Recommendations provided insight into care delivery innovation opportunities and potential policy changes to address equitable access to care. Conclusion: Integration of telehealth into models of care delivery could improve access to health care services and promote communication among providers and patients to improve care quality. Our findings have implications that are critical for future policy reforms and telehealth research.

Family Perceptions of Health Care Access for Autistic Young Adults Receiving Disability Services.

Autistic young adults (YAs) often live with family and present with complex health needs. Adults with developmental disabilities (DDs) who live with family are the least likely to receive preventive health care compared with residents of other settings. No published studies have examined intersectionality between age, race or ethnicity, household income, and health needs in health care access for autistic YA. This study explored health care access among autistic YAs receiving state DD services compared with other age and disability groups. We analyzed data from the National Core Indicator's Adult Family Survey of families of DD service users ages 18 and older who lived in the respondent's home. We used bivariate analyses and multivariable logistic regression to examine family-reported access to health care providers when needed, the role of sociodemographics, and the complexity of health care needs in predicting consistent care. Approximately 70% of autistic YAs had consistent access to health care when needed, similar to autistic adults but at lower rates than those with other disabilities. Odds of consistent health care access were higher among autistic YAs who were Black or lived in a rural area and lower among those with co-occurring health conditions or who needed extensive personal care support. Nearly one-third of autistic YAs who lived with family and receive state DD services had difficulty consistently accessing needed health care. Improved surveillance of health care services in this population is needed in addition to innovations in Medicaid waivers, which fund DD services, to address health needs and support families in accessing care.

Health Dynamics in the Built Environment: An Urban Intensity Perspective - An Exploratory Study in Trinidad and Tobago.

The built environment encompasses the physical components of the environment, inclusive of infrastructure, households, buildings, streets, and open spaces, within which individuals reside and carry out their daily activities. It affects both indirectly and directly on the outdoor and indoor physical environment as well as the socio-economic environment. The elements which comprise the built environment and those of the physical and socio-economic environments, which are affected by it, are recognised as key determinants of health. In this study, health dynamics in the built environment are explored along the urban-rural gradient in Trinidad and Tobago. The gradient is measured by a statistically validated Urban Intensity Index developed previously, using physical data from the built environment. Published physical health data from National Surveys as well as data collected on perceptions of health care access and environmental quality are utilised in conjunction with the Urban Intensity Index values to model chronic illness. Multivariate statistical analysis and maps are used to explore and illustrate these dynamics. Ultimately, the outputs of this study can potentially support efforts to diminish the gap between rhetoric and reality, through provision of critical information for policy and decision making, as the global development agenda moves towards evidence-based policy making.

Geographic and Perceived Healthcare Access Equity among Patients with Acute Cardiovascular Event in China

Introduction: In acute cardiovascular event (ACE) such as stroke and myocardial infarction, access to comprehensive, timely, and quality healthcare services was critical for receiving appropriate treatment and improving prognosis. However, due to significant disparities on distribution of healthcare resources, allocating the limited resources to regions and population in needs was a key challenge for China. This study aimed to evaluate both geographic and perceived healthcare access of ACE patients in China, find inconsistency and furtherly improve it. Methods: This study was conducted in Hangzhou (a capital city of Zhejiang Province in southeast China) city. We conducted a ground-truthed field census to locate and confirm all institutions based on their locations. Geographic Information System (GIS) was used to analyze the geographic healthcare access (e.g. distance to nearest institution, density of institutions in the area etc.) and potential distribution disparities. Meanwhile, we sampled 21 ACE patients from one typical hospital in Shangcheng District in a pilot study, and a questionnaire-based face-to-face survey was conducted to collect data on perceptions of healthcare access, including perceived presence of institutions, perceived distance to nearest institution, perceived affordability of healthcare etc. Results: A number of 2,763 healthcare institutions were recognized, confirmed and geocoded in the GIS. The geographic healthcare access was excellent for city residents and over 95% of the city areas were within 15-minute access-buffer. However, only 10.2% institutions could provide emergency services and among them only 7.8% institutions could provide emergency services for ACE patients. Based on patient survey, approximately 33.3% ACE patients reported healthcare access was not good in their living areas. Average perceived distance and time to the nearest healthcare institution were 6.9±4.7 km and 23.8±13.7 minutes, respectively. The majority of the patients reported that no emergency services were localized near their homes. When the ACEs happened, 85.7% of the patients were transported by the ambulance. Discussion: The knowledge generated from this study could form a basis for understanding of healthcare access in China. Access to emergency healthcare services was poor in some areas in the city. The mapping data showed an excellent healthcare access for residents, but the patients did not all perceive this. Compared to geographic data, patients perceived longer distance and duration of time to the nearest healthcare institution. The inconsistence might be due to the traffic condition in city area, urban planning, mode of transportation, and inconsistence of accessibility captured by GIS and perceptions. Lessons learned: The findings of this proposed study would guide policy deliberations and healthcare resources allocations. It would provide instrumental information for policy makers to target interventions to improve both geographic and perceived healthcare access. Limitations: The recruitment of patient survey was limited at the pilot stage. We planned to expand the sample size into more areas and linked healthcare access to ACE outcomes to further evaluate the impact of healthcare access on health, and thus find more potentials for policy intervention. Funding: This work was supported by the Open Competition grant from the China Medical Board (14-197).

A Partisan Divide on the Uninsured

The partisan split in Congress over health reform may reflect a broader divide among the public in attitudes toward the uninsured. Despite expert consensus over the harms suffered by the uninsured as a group, Americans disagree over whether the uninsured get the care they need and whether reform legislation providing universal coverage is necessary.We examined public perceptions of health care access and quality for the uninsured over time, and we found that Democrats are far more likely than Republicans to believe that the uninsured have difficulty gaining access to care. Senior citizens are less aware than others of the problems faced by the uninsured. Even among those Americans who perceive that the uninsured have poor access to care, Republicans are significantly less likely than Democrats to support reform. Thus, our findings indicate that even if political obstacles are overcome and health reform is enacted, future political support for ongoing financing to cover the uninsured could be uncertain.

A Partisan Divide On The Uninsured

The partisan split in Congress over health reform may reflect a broader divide among the public in attitudes toward the uninsured. Despite expert consensus over the harms suffered by the uninsured as a group, Americans disagree over whether the uninsured get the care they need and whether reform legislation providing universal coverage is necessary. We examined public perceptions of health care access and quality for the uninsured over time, and we found that Democrats are far more likely than Republicans to believe that the uninsured have difficulty gaining access to care. Senior citizens are less aware than others of the problems faced by the uninsured. Even among those Americans who perceive that the uninsured have poor access to care, Republicans are significantly less likely than Democrats to support reform. Thus, our findings indicate that even if political obstacles are overcome and health reform is enacted, future political support for ongoing financing to cover the uninsured could be uncertain.

Mexican Immigrant Women’s Perceptions of Health Care Access for Stigmatizing Illnesses: A Focus Group Study in Albuquerque, New Mexico

This study examines attitudes of Mexican female immigrants to Albuquerque, New Mexico, regarding barriers to health care access in the United States and Mexico for stigmatizing and non-stigmatizing illnesses and moderating effects of social support. Native Spanish speakers conducted three focus groups (in Spanish) lasting two hours with seven to eight participants. Focus groups were transcribed, translated, and coded. Frequency data were calculated by number of times concepts or themes were raised. Comparisons of barriers to health care access were made between U.S. and Mexican cultures. The majority (86%) of comments on barriers for non-stigmatizing illnesses implicated U.S. culture; the majority (90%) for stigmatizing illnesses implicated Mexican culture. Social support for stigmatizing illnesses was discussed. Participants discussed important issues of health care access for stigmatizing illnesses that may have implications for this population's health status. Greater attention should be paid to stigma and social support in future empirical studies.

Disparities in Perceptions of Healthcare Access in a Community Sample

Disparities in health status persist for many sociodemographic groups in the United States. An understanding of barriers to healthcare access and utilization can assist community-based initiatives in developing strategies to improve the health of minority and low-income populations. Using self-reported information from 3014 community residents, a factor analysis was conducted that defined barriers to healthcare by 4 dimensions: (1) time and competing priorities, (2) convenience and availability, (3) healthcare utilization, and (4) healthcare affordability. Differential effects of demographics were observed on all factors. Racial disparities were found where African Americans experienced more problems based on the convenience and availability of services (P < .02) than did whites, after controlling for income, education, age, and marital status. In addition, gender differences showed that women experienced greater difficulty with time and competing priorities than men (P < .001); however, women experienced fewer problems related to utilization (P < .001). Of the covariates, income was significant (P < .01) on 3 of the 4 indicators. This study points to the need to develop interventions that address the unique challenges faced by different population groups to ensure timely healthcare. In addition, the reduction of economic disparities should be considered as an important strategy to improve public health.

Perceived Barriers to Health Care Access Among Rural Older Adults: A Qualitative Study

Many rural elders experience limited access to health care. The majority of what we know about this issue has been based upon quantitative studies, yet qualitative studies might offer additional insight into individual perceptions of health care access. To examine what barriers rural elders report when accessing needed health care, including how they cope with the high cost of prescription medication. During Spring 2001, thirteen 90-minute focus groups were conducted in 6 rural West Virginia communities. A total of 101 participants, aged 60 years and older, were asked several culminating questions about their perceptions of health care access. Five categories of barriers to health care emerged from the discussions: transportation difficulties, limited health care supply, lack of quality health care, social isolation, and financial constraints. In addition, 6 diverse coping strategies for dealing with the cost of prescription medication were discussed. They included: reducing dosage or doing without, limiting other expenses, relying on family assistance, supplementing with alternative medicine, shopping around for cheapest prices, and using the Veteran's Administration. Overall, rural older adults encounter various barriers to accessing needed health care. Qualitative methodology allows rural elders to have a voice to expound on their experiences. Research can contribute valuable information to shape policy by providing a forum where older adults can express their concerns about the current health care delivery system.

Medicare health maintenance organizations and traditional coverage: Perceptions of health care among beneficiaries with disabilities

Beatty PW, Dhont KR. Medicare health maintenance organizations and traditional coverage: perceptions of health care among beneficiaries with disabilities. Arch Phys Med Rehabil 2001;82:1009-17. Objective: To determine whether perceptions of access to, affordability of, and quality of health care services differ for Medicare beneficiaries with disabilities in health maintenance organizations (HMOs) and traditional Medicare coverage. Design: Bivariate and multivariate analyses were conducted to determine the relationship between Medicare coverage type and perceptions of health care access, affordability, and quality. Setting: Noninstitutionalized Medicare beneficiaries across the United States. Participants: A random sample of 6116 beneficiaries who qualify for Medicare as working-age disabled (n = 2250), or who qualify as elderly and have at least 1 instrumental activities of daily living limitation (n = 3866). This subsample of the nationally representative Medicare Current Beneficiary Survey (MCBS) represents 11,627,107 beneficiaries with disabilities. Intervention: Questions about perception of access to primary care, affordability of care, and quality of care. Data derived from the 1994 MCBS Access to Care File. Main Outcome Measures: Dependent variables: perceptions of access to primary care, affordability, and satisfaction with quality of care. Independent variables: indicators of managed care status and health status level, severity of disability, Medicare qualification, age, and gender. Results: Beneficiaries with disabilities in HMOs perceive better access to primary care services, and greater affordability of health services than those with traditional Medicare coverage. Beneficiaries in poor health or with the most severe disabilities were most likely to perceive access and cost difficulties, regardless of coverage type. Conclusion: Medicare managed care appears generally to be meeting 2 of its goals—better access to primary care and more affordable care—though these advantages are not being shared by those with poor health status and/or severe disabilities. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation