Seeking Health Care Services Research Articles

Beyond the Individual: Social and Cultural Influences on the Health-Seeking Behaviors of African American Men.

Morbidity and mortality rates are alarmingly high among African American men and are influenced by the health-seeking behaviors of this population. This study examined data from 40 focus groups with African American men in Durham, North Carolina, to better understand social and cultural influences on health-seeking behaviors. Data were analyzed using inductive thematic analysis. Three broad types of social/cultural influence on motivation to seek health care services were identified: family, culture and upbringing, and peers. Study findings confirm the importance of social relationships in influencing African American men’s health-seeking behaviors and offer characterization of the nature of influence across different types of relationships, according to the direct support or indirect messages they provide. Future programs can draw on these data to inform efforts to include family and peers as well as utilize existing cultural gender norms to the advantage of health promotion for African American men.

Trauma-Informed Care and Health Among LGBTQ Intimate Partner Violence Survivors.

Intimate partner violence (IPV) and its health consequences occur among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals at rates equal to or higher than cisgender heterosexual individuals. Trauma-informed care (TIC) is one service approach with emerging empirical support for use with IPV survivors, but without attention to the LGBTQ population. Structural equation modeling was used to assess associations between TIC and mental and physical health through several mechanisms among 239 LGBTQ adults who had experienced IPV and sought healthcare services within the past year (Mage = 27.66; 66.7% White; 43.9% cisgender women). Participants reported their perceptions of TIC in their services received; their sense of empowerment, emotion regulation, shame, and social withdrawal (all conceived as mobilizing mechanisms through which TIC could be associated with health); and their mental health (depression and posttraumatic stress disorder [PTSD]), and physical health (somatic symptoms and chronic health conditions). Those who perceived greater TIC in their services reported greater empowerment and emotion regulation, and lower social withdrawal. In turn, lower social withdrawal and shame were associated with better mental health, while lower shame also was associated with better physical health. Indirect associations between TIC and mental and physical health through the four mobilizing mechanisms were not significant, however, with the exception of a small indirect effect on mental health through lower social withdrawal. Results suggest that practitioners need to develop services to be used in conjunction with a general TIC approach to improve health and target shame among LGBTQ IPV survivors.

Illuminating Mexican Migrant Adolescents' Dental Access and Utilization Experiences.

To illuminate Mexican migrant adolescents' dental access and utilization experiences. Qualitative focus groups were conducted in English between July 2015 and March 2016 as part of a community-based participatory research project. Adolescents (n=61) aged 12-19 years, from Mexican migrant worker families, who sought healthcare services at a federally-qualified migrant health clinic in San Diego County, California. Seven focus groups, with different sessions for 12-14, 15-16, and 17-19 year olds. Group size ranged from 4-14. Groups were audio-recorded, transcribed verbatim, then analyzed using content and general thematic analyses by two researchers using Dedoose qualitative analysis software. Analysis was guided by the Behavioral Model for Vulnerable Populations. Multiple themes emerged: dental fear, difficulty with scheduling dental appointments, competing with family demands, family income and dental tourism, home remedies, lack of direct adolescent-provider communication, and negative dental visit experiences. Adolescents expressed high levels of dental fear and expressed negative dental visit experiences. Cost was a top barrier to care, despite most having dental insurance. Some described seeking dental services and braces in Mexico due to cost. Adolescents wanted providers to discuss their oral health and treatment needs with them directly as patients, rather than with their parents. Adolescents identified structural and communication barriers that impede access to dental care. Improved patient-provider communication may help build rapport, mitigate dental fear, and facilitate adolescents' understanding of needed dental treatment and their oral health status. Dental providers may benefit from training to enhance culturally competent communication with Mexican migrant adolescents, and should discuss treatment plans with adolescent patients directly.

Masculinities inherent to the Brazilian men's health policyLa masculinidad inherente a la política sobre la salud del hombre en Brasil

RESUMOProblematiza-se neste artigo a incorporação da dimensão das masculinidades como fomentadora de estratégias de gestão na Política Nacional de Atenção Integral à Saúde do Homem (PNAISH) brasileira. A leitura aprofundada sobre as masculinidades percebidas em seu caráter interseccional pode aprimorar o contexto atual de revisão dessa política, principalmente quando características socioculturais marcantes brasileiras, como a desigualdade social e o racismo, estão diretamente associadas aos altos índices de agravos em saúde e mortalidade de homens negros, pobres e jovens em decorrência da violência urbana. Percebe-se que os discursos que colocam os homens como sujeitos que buscam os serviços de saúde apenas quando há agravamento dos sintomas são desprovidos de uma leitura que reconheça que os marcadores sociais da diferença, como classe social e raça, produzem iniquidades em saúde. A interseccionalidade permite uma visão do acesso aos serviços de saúde como dependente do território onde os homens circulam e dos meios (sociais, políticos) que influenciam o seu reconhecimento como sujeitos de direito. Tendo em vista que determinadas masculinidades são invisíveis no interior de políticas públicas de saúde, aprofunda-se a leitura acerca de masculinidade e saúde numa perspectiva pós-estruturalista, enquanto fomentadora de modos de pensar e fazer gestão em saúde do homem. Por fim, são descritos aspectos indispensáveis aos processos de revisão das diretrizes de políticas destinadas a essa população.

Crime, recidivism and mental disorders among prisoners in Mbarara municipality, southwestern Uganda

IntroductionMental disorders among prisoners have been linked to the type of crime and recidivism. Identification of the mental disorders associated with the different types of crimes and recidivism is essential in the planning and eventual service provision to the prisoners. This study aimed to determine the association between mental disorders, type of crime and recidivism among prisoners in Mbarara municipality in Uganda. MethodsThis was a prison facility based cross-sectional study among 414 male and female inmates in Mbarara municipality conducted from June to July 2017. Participants were enrolled from 3 prison facilities through simple random sampling. Sociodemographic-clinical factor questionnaires, and the M.I.N.I. Version 6.0 were completed by each participant. Bivariate and multivariate logistic regression analyses were conducted to determine the associations between the various mental disorders, type of crime and recidivism using the individual adjusted odds ratios at 95% CI. Data were analyzed using STATA 12.0. ResultsOf all the 414 participants in this study; 94% were male, 60% were aged 22–35 years, 89% were first-time offenders, and 64% had allegedly committed or been convicted of violent crimes. Social anxiety disorder was significantly associated with non-violent crimes. Major depression was more likely to occur in recidivists whereas panic disorders were more frequent among first-time offenders regardless of their gender. ConclusionsAn association was established between the category of crime, recidivism, and type of mental disorder among prisoners participating in the study in Mbarara municipality, southwestern Uganda. Additional findings were that a majority of the prisoners with mental disorders seek health care services from the prison health facility and of these inmates, few are accessing psychiatric treatment.

Out of the Closet, Into the Clinic: Opportunities for Expanding Men Who Have Sex With Men-Competent Services in China.

Despite the high human immunodeficiency virus (HIV) burden among men who have sex with men (MSM), there is little research on health services provided to MSM in China and other low- and middle-income countries. Discrimination and inadequate services may discourage MSM from seeking health care services. This study examined essential services provided to MSM and health care discrimination among MSM in China. A nationwide cross-sectional online survey was conducted among MSM who saw a physician in the last 24 months in China. The survey included items on sociodemographic information, HIV testing, experiences from the last physician encounter, and history of perceived health care discrimination. We defined MSM-competent physicians as physicians who asked their patient about having sex with other men, asked about anal sex, and either asked about or recommended HIV testing at the most recent visit. Among the 503 participants, 35.0% (176/503) saw an MSM-competent physician. In multivariate analyses, respondents who saw an MSM-competent physician were more likely to be younger (adjusted odds ratio [AOR], 0.87; 95% confidence interval [CI], 0.81-0.94), have a primary care physician (AOR, 3.24; 95% CI, 1.85-5.67), and be living with HIV (AOR, 2.01; 95% CI, 1.13-3.56). 61.2% (308/503) of MSM had ever experienced health care discrimination. Our data suggest that there is variability in the extent to which physicians are meeting the needs of MSM in China. There is an urgent need to evaluate and expand MSM-competent services in China.

Patient satisfaction with nurse practitioner care in Newfoundland and Labrador

Objective: The aim of the study was to determine the level of patient satisfaction with health care provided by Nurse Practitioners (NPs) in Newfoundland and Labrador (NL), in primary health care settings.Methods: This is a descriptive study. 155 adult patients (N = 155) were recruited from the four regional health authorities (RHAs) throughout NL who employed NPs in a primary health care setting. A 47-item questionnaire called the Nurse Practitioner Satisfaction Survey (NPSS) was given to patients after receiving care from a NP.Results: Over 93% of the participants agreed or strongly agreed with their degree of satisfaction of care provided by the NP. Patients who visited the NP one to five times in the past year reported higher levels of satisfaction. No significant differences based upon marital status, gender or ethnicity were found.Conclusions: Patient satisfaction was rated as high for care provided by NPs with over 98% of participants reporting they would seek the services of a NP in the future. The majority of the participants would recommend the NP to others seeking health care services. This study describes patient satisfaction with NP care and highlights NPs as valued providers of care in rural and urban primary health care settings. Identified narrative themes were timely access to care, NP knowledge, trust, and provider consistency. NPs should seek ways to ensure they work to their full scope of practice to meet the needs of the population and increase their presence in primary health care settings.

Somatization

Abstract An evaluator's failure to recognize illness behavior and to adjust for its effect on symptom presentation can lead to erroneous conclusions regarding impairment or disability; here the authors review the associated phenomena of somatization, disorders that arise from it, and factors that contribute to somatization. Somatization is an individual's unconscious use of the body or bodily symptoms for psychological purposes or psychological gain. As the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, notes, somatization is a “tendency to experience and report somatic complaints (physical symptoms) in response to psychosocial stress and seek health care services for them.” The AMA Guides also advises evaluators that “exclusion or inclusion of somatization disorder, factitious disorder, and/or malingering must be done with care.” A table lists developmental factors that may dispose to somatization (eg, somatizers are present in the family of origin, or coping mechanisms other than illness behavior are absent or unacceptable); a second table compares disorders that may involve somatization. Somatization is prevalent in clinical practice and is likely to occur with equal, or higher, frequency in the evaluation setting. The presence of somatization distorts symptom presentation and can exert a confounding effect on impairment assessment methodologies that rely on the accuracy of patients’ self-presentations.

Health Seeking Behavior among Mentally and Physically Ill Patients: A Comparative Study

Health-seeking behaviour has been defined as a sequence of remedial actions that individuals undertake to rectify perceived ill-health. Therefore, this study was to assess the barriers affecting seeking health care services as perceived by mentally and physically ill patients. A descriptive comparative design was utilized in this study. A sample of convenience of 100 patients (50 physically ill patients and 50 mentally ill patients) was recruited for the conduction of this study. Socio-demographic/medical data sheet, barriers affecting seeking health care services questionnaire were used for data collection. Findings of this study indicated that, near half of studied sample of patients with mental illness express severe level of difficulties in seeking health care services as compared to more than one third of patients with physical diseases. Meanwhile, more than one third of studied sample of patients with mental illness express moderate level of difficulties in seeking health care services as compared to two thirds of patients with physical diseases. To conclude no statistical difference was found between patients with mental illness and patients with physical disease in relation to barriers affecting seeking health care services. Further studies on a larger number of patients with different diagnoses from different geographical areas are recommended

The need for trust and safety inducing encounters: a qualitative exploration of women\u2019s experiences of seeking perinatal care when living as undocumented migrants in Sweden

BackgroundStudies from around the world have shown that women living as undocumented migrants have limited and deficient access to perinatal care, increasing their risks of both physical and psychological complications during pregnancy and childbirth. Failures to provide equal access to healthcare have been criticized extensively by the United Nations. In 2013, undocumented migrants’ rights to healthcare in Sweden were expanded to include full access to perinatal care. Research surrounding clinical encounters involving women living as undocumented migrants remains largely lacking. The present study aimed to provide a composite description of women’s experiences of clinical encounters throughout pregnancy and childbirth, when living as undocumented migrants in Sweden.MethodsTaking an inductive approach, qualitative content analysis was implemented. Thirteen women from ten different countries were interviewed. Meaning-units were extracted from the data collected in order to identify emergent overarching themes.ResultsIn clinical encounters where healthcare professionals displayed empathic concern and listening behaviours, women felt empowered, acknowledged, and encouraged, leading them to trust clinicians, diminishing fears relating to seeking healthcare services. Conversely, when neglectful behaviour on part of healthcare professionals was perceived in encounters, anxiousness and fear intensified. Vulnerability and distress induced by the women’s uncertain living circumstances were apparent across themes, and appeared exacerbated by traumatic memories, difficulties in coping with motherhood, and fears of deportation.ConclusionThe present study contributes unique and important knowledge surrounding women’s experience of being pregnant and giving birth when living as undocumented migrants. The overarching findings indicated that the needs of undocumented migrant women were largely similar to those of all expectant mothers, but that due to vulnerabilities relating to their circumstances, flexible and informed care provision is essential. Being knowledgeable on undocumented migrants’ rights to healthcare is vital, as clinical encounters appeared highly consequential to the women’s well-being and help-seeking behaviours. Negative encounters inflicted emotional distress and fear. Contrastingly, positive encounters promoted trust in clinicians, personal empowerment, and relief. Positive clinical encounters could provide rare opportunities to assist an otherwise elusive population at increased risk for both physical and psychological complications, highlighting the crucial need for adherence to ethical principles in clinical practice.

Health out of foster care as young adults age out of foster care: A phenomenological exploration of seeking healthcare services after aging out of the US foster care system

Some adolescents in the United States who have been abused and/or neglected by caregivers and placed in permanent custody of the state leave, or “age out” of foster care at 18 years of age. Poor health outcomes among individuals who age out are notable, yet few studies describe the phenomenon of seeking healthcare services after leaving foster care. The investigators specifically queried the phenomenon of seeking healthcare services after foster care drawing from the Phenomenology of Practice approach. We interviewed 13 young adults who aged out of care. Investigators extracted lived experience descriptions (LEDs) from interview transcripts and analyzed under phenomenological themes. Healthcare experiences were marked by avoiding self-disclosure, having no choice but to wait, missing family history, and relying on the kindness of strangers. Healthcare providers who integrate the findings into care delivery models will engage young adults with more understanding and sensitivities of ethical practice.

Health-Related Internet Use by Children and Adolescents: Systematic Review.

BackgroundThe internet is widely used by children and adolescents, who generally have a high level of competency with technology. Thus, the internet has become a great resource for supporting youth self-care and health-related services. However, few studies have explored adolescents’ internet use for health-related matters.ObjectiveThe objective of this systematic literature review was to examine the phenomenon of children and adolescents’ health-related internet use and to identify gaps in the research.MethodsA total of 19 studies were selected from a search of major electronic databases: PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO using the following search terms: “health-related internet use,” “eHealth,” “Internet use for health-related purpose,” “Web-based resource,” “health information seeking,” and “online resource,” combined with “child,” “adolescent,” “student,” “youth,” and “teen.” The children’s and adolescents’ ages were limited to 24 years and younger. The search was conducted from September 2015 to October 2017. The studies identified to contain youth (<24 years) health-related internet use were all published in peer-reviewed journals in the past 10 years; these studies examined general internet use seeking health care services, resources, information, or using the internet for health promotion and self-care. Studies were excluded if they explored the role of the internet as a modality for surveys, recruitment, or searching for relevant literature without specifically aiming to study participants’ health-related internet use; focused solely on quality assurance for specific websites; or were designed to test a specific internet-based intervention.ResultsInteresting patterns in adolescents’ health-related internet use, such as seeking preventative health care and specific information about medical issues, were identified. Quantitative studies reported rates of the internet use and access among youth, and the purpose and patterns of health-related internet use among youth were identified. A major objective of health-related internet use is to gain information, but there are inconsistencies in adolescents’ perceptions of health-related internet use.ConclusionsThis study’s findings provide important information on how youth seek information and related support systems for their health care on the internet. The conceptual and methodological limitations of the identified studies, such as the lack of a theoretical background and unrepresentative samples, are discussed, and gaps within the studies are identified for future research. This review also suggests important features for potential Web-based health interventions for children and adolescents.

Demographic and clinical characteristics associated with trauma exposure among Latinas in primary medical care

ABSTRACT Latina immigrants are an underserved population with complex medical and mental health needs. This population has high rates of trauma exposure, compounding their health issues. However, little is known about the characteristics of trauma-exposed Latina immigrants who seek health care services. This study analyzes the health records of Latina women (N = 153), most of whom were immigrants, receiving medical and mental health care services at an urban primary care clinic. These women had high rates of trauma exposure and were both medically and psychiatrically complex, with the majority undiagnosed and having no prior trauma-related treatment. Practice implications are discussed.

Medical tourism gaining grounds in India: present scenario and way forward

Medical tourism (also called medical travel, health tourism or global health care) is a term used to describe the rapidly-growing practice of travelling across international borders to seek healthcare services

Health seeking behavior and its determinants for cervical cancer among women of childbearing age in Hossana Town, Hadiya zone, Southern Ethiopia: community based cross sectional study

BackgroundCervical cancer is one of the most easily preventable forms of female cancers if early screening and diagnosis is made. Low awareness level about the disease and risk factors, beliefs about the disease, poor access to preventive services, affordability of the service and current health service system can influence decision to seek health care services for cervical cancer. The objective of this study was to determine health seeking behaviour and determinant factors for cervical cancer in Hossana town.MethodsOur study was carried out in Hossana town using community based cross-sectional study design. The study population was women of childbearing age (15–49 years) who had the chance of being randomly selected from the source population. Five hundred ninety five women of childbearing age were included in the study. Systematic random sampling technique was employed to select the study units. Structured and pretested questionnaire was used to collect the data. The collected data were cleaned and entered by EPI info version 3.5.4 and analysed by SPSS version 16. We considered P-value < 0.05 to decide statistically significant association between the independent and dependent variables.ResultsThe prevalence of health seeking behaviour for cervical cancer among the study participants was only 14.2%. Respondents’ poor knowledge [AOR: 7.25, 95% CI: (1.87, 28.08)], not ever received information [AOR: 52.03, 95% CI: (13.77, 196.52)] and not actively searching information about cervical cancer [AOR: 14.23, (95%CI: (3.49, 57.95)] were significantly associated factors with not seeking health for prevention and control of cervical cancer.ConclusionThe prevalence of health seeking behaviour for cervical cancer is low. Respondent’ poor knowledge, not ever received information, and not actively searching information about cervical cancer are significantly associated with not seeking health for cervical cancer prevention and control. This study stressed the importance of increasing knowledge, promoting active search of health information and experiences of receiving information from different sources regarding health seeking behaviour.

Barriers to Healthcare Services for People with Disabilities in Developing Countries: A Literature Review

Purpose: This literature review aimed to identify the main barriers in access to mainstream healthcare services for people with disabilities.Method: Online databases were searched for relevant articles published after 2006. Preference was given to articles pertaining to developing countries. On the basis of pre-determined inclusion and exclusion criteria, 16 articles were selected for the review. Barriers noted in the articles were grouped thematically.Results: There appeared to be 7 main barriers - 4 related to the demand side i.e., pertaining to the individual seeking healthcare services, and 3 barriers on the supply side i.e., pertaining to healthcare provision. These are: 1) Lack of information; 2) Additional costs of healthcare; 3) Limited mobility; and, on the demand side, 4) Stigmatisation; while on the supply side, 5) Staff attitude; 6) Communication barriers; and, 7) Inaccessible facilities.Conclusion: To ensure that people with disabilities can successfully access the necessary health services, the barriers on the demand side (the individuals requiring healthcare) as well as the barriers that are part of the healthcare system, should be attended to.

Cases diagnosis of imported malaria in Jiangsu province, 2014-2016

Objective: To understand the situation related to health seeking and diagnosis of imported malaria and to provide practical measures for malaria elimination in Jiangsu province. Methods: Data on imported malaria cases in Jiangsu province was retrieved in CISDCP from 2014 to 2016. Relevant information on health seeking behavior, diagnosis and treatment of the disease was gathered. Results: A total of 1 068 imported cases were reported in Jiangsu province from 2014 to 2016. Except for one malaria case that was caused by blood transfusion, the rest patients were all recognized as 'imported'. Majority of the cases were migrant laborers working in African countries. The accurate rates on the diagnosis of ovale, vivax and quartan malaria and mixed infection were relatively low, as 79.3% (107/135), 29.5% (18/61), 52.9% (18/34) and 0.0% (0/2) at the primary health care settings, respectively. Rate of seeking health care on the same day of onset was more in 2015 than in 2014 and 2016 (χ(2)=18.6, P=0.001). While only 65.4% (699/1 068) of the patients were diagnosed correctly at the primary health care settings. There appeared no statistical difference in the 3-year-study period (χ(2)=5.4, P=0.246). Capacity on 'correct diagnosis' seemed stronger at the CDC than at the hospital levels (χ(2)=13.2, P=0.000; χ(2)=5.4, P=0.020). Totally, 72.7% (32/44) of the severe falciparum malaria cases did not immediately seek for health care when the symptoms started. Conclusions: Migrant workers returning from the high endemic malaria areas seemed to have poor awareness in seeking health care services. Capability on correct diagnosis for malaria at the primary health care settings remained unsatisfactory and staff from these settings needs to receive adequate training.

Mobile health communication: Effective reduction of patients’ travel needs to hospitals

ABSTRACTThe increasing use of mobile telephone technology is having significant implications for the study of urban travel. This is because mobile communication has brought about tremendous improvements in person-to-person connectivity. Existing literature has established the fact that the heavy traffic congestion in Lagos has adversely affected the movement of patients to the hospital. This paper examined the effectiveness of mobile telephone usage on trip reduction to healthcare centres. The Telecommuting and Travel Concept (TTC) provided the framework for the study. Using a systematic random sampling technique, a structured questionnaire focusing on socio-economic characteristics of out-patients, mobile telephone usage to seek healthcare services, travel behaviour, and eliminated trips to healthcare centres were administered on 711 out-patients. Results showed that mobile communication between patients and medical doctors predicted a significant reduction in patients’ trips to healthcare centre (r = 0.891). This study recommends that public health policy-makers should encourage mobile communication usage to further reduce the number of trips made to healthcare centres in order to increase access to healthcare services in Nigeria.

Mental disorders and employment status in the São Paulo Metropolitan Area, Brazil: gender differences and use of health services.

Mental disorders are associated with employment status as significant predictors and as consequences of unemployment and early retirement. This study describes the estimates and associations of 12-month DSM-IV prevalence rates of mental disorders and use of health services with employment status by gender in the São Paulo Metropolitan Area, Brazil. Data from the São Paulo Megacity Mental Health Survey was analyzed (n = 5,037). This is a population-based study assessing the prevalence and determinants of mental disorders among adults, using the Composite International Diagnostic Interview. The associations were estimated by odds ratios obtained through binomial and multinomial logistic regression. This study demonstrates that having mental disorders, especially mood disorders, is associated with being inactive or unemployed among men and inactive among women, but only having a substance use disorder is associated with being unemployed among women. Among those with mental disorders, seeking health care services is less frequent within unemployed.

Is price most important? Healthcare tourism in Southeast Asia

ABSTRACTHealthcare tourism is a general term for traveling to another country to seek healthcare services. It spread from Western countries to emerging Southeast Asian nations in the past decade because of a series of factors. Price is likely considered as one of the important factors among most healthcare tourism providers and politicians. However, healthcare tourists tend to consider more before making a decision. According to some early studies, healthcare quality, package, convenience, country, price, emotional value, and social value were frequently considered factors. To examine the role of these factors, this study proposes a structural model to investigate the relationship of the perceived value, satisfaction, and behavioral intentions of three Southeast Asian countries, namely Singapore, Thailand, and Malaysia. A sample of size 724 is collected at the Departure Hall of the Singapore Changi International Airport within a two-month period, using a systematic random sampling method, in which every third tourist who pass the surveyor is asked to fill in the questionnaire. All of the questionnaires handed out on a given day referred to the same country, and the three different countries are rotated on different days. All factors are significant and it is found that the two most important factors are functional value of healthcare quality and emotional value. Price is a significant but the least important factor. This indicates that cheaper price may be just a promotional gimmick or an obvious incentive, but it is not the main driving force for healthcare tourists to make their decisions. The results also provide empirical support that emphasis on perceived value of healthcare tourism may also translate into trust in the staff and other positive feelings. It is further found that the impact of perceived value on behavioral intentions is mediated by satisfaction for all three countries.