Self-reported Need Research Articles

Refraining from seeking dental care among the Sámi in Sweden: a cross-sectional study

BackgroundWhile equity in health care is the core of the Swedish health system, social inequalities in accessing health care, particularly regarding dental care, exist. There is however no information on how the Sámi population is affected. This study aimed to assess the prevalence and risk factors for refraining from seeking dental care among the Sámi in Sweden.MethodsA Sámi sample was constructed from three pre-existing registers. Among the 9,249 invitations for individuals aged 18–84 years old, 3,779 answered the survey during February–May 2021. We first calculated frequencies and proportions of the independent variables in terms of socio-economic, socio-demographic, and cultural-related factors as well as the outcome, refraining from dental care. Then, we summarized the magnitude of the association between the independent variables and self-reported refrain from dental care with the prevalence difference (PD) using the 95% confidence interval (95% CI) for inferential purposes.ResultsOverall, 17.5% of the participants refrained from seeking dental care despite self-reported need in the last three months, with almost the same proportion between men and women. Among the socio-demographic factors, being in the 30–44 years group (PD = 8.0; 95% CI: 3.59, 12.48), in the 45–64 group (PD = 7.3; 95% CI: 2.96, 11.61) and in the 65–84 group (PD = 5.4; 95% CI: 0.92, 9.78) as well as being divorced/widow-er (PD = 6.7; 95% CI: 2.73, 10.70) and unmarried (PD = 3.1; 95% CI: 0.23, 6.04) were statistically significantly associated with refraining from seeking dental care. Among the socio-economic variables, those in the middle-income quintile (PD = 5.3; 95% CI: 1.28, 9.35), in the poor (PD = 8.1; 95% CI: 3.64, 12.51) and poorest (PD = 8.0 95% CI: 3.48, 12.50) quintiles, and especially those experiencing economic stress once (PD = 9.2; 95% CI: 2.93, 15.48) and several times (PD = 26.5; 95% CI: 19.50, 33.43), were strongly associated with refraining.ConclusionsApproximately one in six of the Sámi participating in this study refrained from seeking dental care despite self-reported need in the last three months. Those who experienced economic difficulties were the most affected group. To achieve equity in dental health care in Sweden, policies removing economic barriers to access dental health care should be implemented.

Nurse-related behavioural determinants associated with healthy eating support provided by Dutch community nurses: a cross-sectional study

BackgroundCommunity nurses (CNs) play an important role in supporting healthy lifestyles, including healthy eating behaviour of patients. However, many CNs do not incorporate healthy eating support in their daily routines to the fullest extent possible. This study aimed to explore (1) the associations between nurse-related behavioural determinants and self-reported healthy eating support practices of Dutch CNs and (2) CNs’ need for additional knowledge.MethodsIn this cross-sectional survey design, 244 Dutch CNs completed an online, self-administered questionnaire in October-November 2021. The 60 questionnaire items were related to CNs’ characteristics, nurse-related determinants, healthy eating support practices (observing problems, having a conversation about patients’ dietary behaviour, motivating patients to eat and drink healthier and supporting patients in goal setting) and the need for additional knowledge. The items on determinants and practices used a 5-point Likert scale. Adjusted prevalence ratios (PRadjusted) with 95% confidence intervals (95%CIs) were obtained for the associations between determinants and practices, using adjusted Poisson regression with robust variance estimations.ResultsMore CNs practiced observing problems (75%) and having a conversation (70%) than did motivating patients (45%) and supporting goal setting (28%) at least often. A more positive attitude (PRadjusted 1.8; 95%CI 1.5–2.2), greater self-efficacy (PRadjusted 1.3; 95%CI 1.1–1.5), greater motivation (PRadjusted 1.5; 95%CI 1.3–1.7) and better abilities (PRadjusted 1.4; 95%CI 1.2–1.6) were associated with a greater prevalence of supporting healthy eating at least often (vs. never to sometimes). Barriers were not associated with healthy eating support (PRadjusted 1.1; 95%CI 1.0-1.2). CNs especially desired more knowledge on diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia; methods for motivating patients to start and for supporting patients to sustain healthy eating; and dealing with patient autonomy.ConclusionsThis study suggests that nurse-related behavioural determinants such as attitude, self-efficacy, motivation and ability should be addressed to improve CNs’ competences in healthy eating support. In addition, based on self-reported need for additional knowledge, it is recommended to pay attention to evidence-based behaviour change techniques, dealing with patient autonomy, and diet in relation to cancer, gastrointestinal diseases, severe psychiatric diseases and dementia.Reporting methodThe STROBE Statement was followed for reporting.

Reasons for not seeking alcohol treatment among a sample of Florida adults with HIV who perceived the need for treatment

BackgroundA minority of people who need alcohol treatment receive it. Unhealthy alcohol use is common among people with HIV (PWH) and can lead to negative health outcomes. The aims of this multi-methods study are to (1) quantitatively describe the prevalence, psychosocial characteristics, and demographic traits of a sample of PWH currently receiving HIV care in Florida who had a self-reported need for alcohol treatment but did not seek care and (2) qualitatively explore reasons why PWH did not seek treatment.MethodsPWH enrolled in the Florida Cohort Study between October 2020 and February 2023 who had drinking history (N = 487) completed a cross-sectional survey that asked if there was a time when they recognized they needed help for their drinking but did not seek it. If yes, they were asked an open-ended follow-up question about reasons why they did not seek care. Demographic and behavioral differences between those who did and did not endorse a time when they needed alcohol treatment were determined using multivariable logistic regression, while qualitative data were analyzed with thematic analysis based in the Social-Ecological Model to assess reasons for not seeking care at the individual, social, and systems levels.ResultsA quarter of PWH (n = 129) with lifetime drinking indicated a time they needed care but did not seek it. Patients who endorsed a time where they perceived the need for treatment but did not seek it were more likely to endorse current at-risk drinking and a history of ever trying to reduce their drinking or formally seek professional alcohol treatment. The most common reasons participants did not seek care were individual level factors and included shame, denial, fear, wanting to do it on their own, not feeling ready, and not wanting to seek care.ConclusionsPWH experienced barriers largely at the individual level that prevented them from seeking alcohol treatment despite a recognized need, though many eventually sought care. Providers and public health professionals should consider helping to address various barriers, particularly internal barriers, when designing interventions to help PWH seek care.

Support from Physicians as a Key Enabling Factor for Rehabilitation Utilization in Migrants with Back Pain: A Longitudinal Analysis

In Germany, medical rehabilitation is provided to promote work ability and health in the case of chronic illness and to avoid early disability pensions. Studies have shown that employees with a history of migration are less likely to seek medical rehabilitation. The aim of this paper was to examine which factors influence the use of medical rehabilitation services in migrants with back pain.We used data from a German cohort study also including migrant employees aged 45 to 59 years. Participants reported back pain in the last 3 months and completed a baseline questionnaire in 2017. Data on rehabilitation utilization was extracted from administrative records covering the period until the end of 2018. Proportional hazard models were fitted to identify factors that were associated with utilized rehabilitation measures.Data of 552 participants were included, and 25 individuals utilized rehabilitation during follow-up. Sex (women: HR = 3.05; 95% CI: 1.10; 8.45), higher job insecurity (HR = 1.02; 95% CI: 1.00; 1.03), support from physicians and therapists (HR = 2.22; 95% CI: 1.52; 3.24), proportion of foreigners (HR = 3.27; 1.17; 9.15), and the self-reported need for rehabilitation (HR = 3.23; 95% CI: 1.12; 8.60) were associated with utilization.In summary, informational and practical support provided by physicians and therapists on medical rehabilitation services seems to be a key predictor of rehabilitation utilization. Our findings, therefore, support the call for transcultural competence to be more widely incorporated into the education of medical and health professionals to counteract health care disparities.

Assistive products for older adults in China: self-reported need, services, and satisfaction

Purpose: Older adults may abandon or discontinue the use of assistive products due to low levels of satisfaction. Only few studies have examined need and satisfaction related to the use of assistive products for this group in China. As such, research is needed to improve satisfaction with assistive products and related services. Method: This study used technology acceptance theory to examine the self-reported need for, and ownership of, assistive products among older adults in China, as well as to examine the association between services and satisfaction with assistive products; the underlying mechanism of this association was also assessed. The current study used the rapid assistive technology assessment (rATA) questionnaire designed by the World Health Organization (WHO) for stratified and cluster sampling. A total of 2,158 older adults living in China were interviewed. The multiple regression analysis was used to examine the independent and interactive associations between services and satisfaction. Heterogeneity and robustness tests were also undertaken.Results: The self-reported need for assistive products pertained mainly to vision, and together with ownership, the need gap has not yet been addressed. Both pre-sale (β = 0.600, p < 0.01) and follow-up services (β = 0.270, p < 0.01) were positively correlated with satisfaction, which in turn shows heterogeneity when it comes to the types of assistive products.Conclusion: Providing accessible services, especially follow-up services, will help older adults be more satisfied with their assistive products, thus ultimately ensuring the continued use of products.

Water, Sanitation, and Hygiene Infrastructure and Resources in Schools in Belize during the COVID-19 Pandemic, 2021-2023.

Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (-11%), functional handwashing access points accessible for individuals with disabilities (-17%) and small children (-29%), and functional alcohol-based hand rub dispensers (-13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures.

Impact of oral health on the quality of life of public servants: an analysis of associated factors.

Oral health encompasses functional and aesthetic aspects that directly impact an individual's daily activities. To analyze the impact of oral health conditions and related factors on the quality of life of public servants. This cross-sectional study was conducted with a sample of 89 public servants, both permanent and outsourced, from a federal public university in northeastern Brazil. Outcome was the impact of oral health on daily activities, determined by the Oral Impacts on Daily Performance indicator, and independent variables were sociodemographic characteristics, normative oral health conditions, access to and use of dental services, self-reported oral morbidity, self-perception of oral health, and absenteeism because of dental reasons. All data were analyzed using descriptive and analytical statistics, using the chi-squared test for heterogeneity and linear trend. The significance level used was set at 5%, with a 95% CI. Participants experienced at least one day of work impaired by dental problems in the six months prior to the survey. Prevalence of dental absenteeism was 7.9%. Variables associated with the impact of oral health on daily activities included gender, toothache, toothache intensity, self-reported oral health, awake bruxism, self-reported need for dentures, number of natural teeth in the upper and lower arches, and signs of temporomandibular dysfunction. Sociodemographic, clinical, and subjective oral health variables influence the impact of oral health on the daily activities of public servants.

Income-based differences in healthcare utilization in relation to mortality in the Swedish population between 2004–2017: A nationwide register study

Background Despite universal healthcare, socioeconomic differences in healthcare utilization (HCU) persist in modern welfare states. However, little is known of how HCU inequalities has developed over time. The aim of this study is to assess time trends of differences in utilization of primary and specialized care for the lowest (Q1) and highest (Q5) income quantiles and compare these to mortality. Methods and findings Using a repeated cross-sectional register-based study design, data on utilization of (i) primary; (ii) specialized outpatient; and (iii) inpatient care, as well as (iv) cause of death, were linked to family income and sociodemographic control variables (for instance, country of origin and marital status). The study sample comprised all individuals 16 years or older residing in Sweden any year during the study period and ranged from 7.1 million in year 2004 to 8.0 million year 2017. HCU and mortality for all disease as well as for the 5 disease groups causing most deaths were compared for the Q1 and Q5 using logistic regression, adjusting for sex, age, marital status, and birth country. The primary outcome measures were adjusted odds ratios (ORs), and regression coefficients of annual changes in these ORs log-transformed. Additionally, we conducted negative binominal regression to calculate adjusted rate ratios (RRs) comparing Q1 and Q5 with regard to number of disease specific healthcare encounters ≤5 years prior to death. In 2017, for all diseases combined, Q1 utilized marginally more primary and specialized outpatient care than Q5 (OR 1.07, 95% CI [1.07, 1.08]; p &lt; 0.001, and OR 1.04, 95% CI [1.04, 1.05]; p &lt; 0.001, respectively), and considerably more inpatient care (OR 1.44, 95% CI [1.43, 1.45]; p &lt; 0.001). The largest relative inequality was observed for mortality (OR 1.78, 95% CI [1.74, 1.82]; p &lt; 0.001). This pattern was broadly reproduced for each of the 5 disease groups. Time trends in HCU inequality varied by level of care. Each year, Q1 (versus Q5) used more inpatient care and suffered increasing mortality rates. However, utilization of primary and specialized outpatient care increased more among Q5 than in Q1. Finally, group differences in number of healthcare encounters ≤5 years prior to death demonstrated a similar pattern. For each disease group, primary and outpatient care encounters were fewer in Q1 than in Q5, while inpatient encounters were similar or higher in Q1. A main limitation of this study is the absence of data on self-reported need for care, which impedes quantifications of HCU inequalities each year. Conclusions Income-related differences in the utilization of primary and specialized outpatient care were considerably smaller than for mortality, and this discrepancy widened with time. Facilitating motivated use of primary and outpatient care among low-income groups could help mitigate the growing health inequalities.

Predicting mental and behavioral health service utilization among child welfare-involved caregivers: A machine learning approach

Caregiver substance misuse (SM) and mental illness (MI) are risk factors for child abuse and neglect and are associated with more intensive CPS involvement including increased risk of foster care placement and multiple re-reports. This study examines the prevalence of SM and MI among 929 CPS-involved caregivers during the early phases of CPS involvement and explores the extent to which family and CPS-case characteristics predict referral and service receipt. We used a machine learning approach to identify the strongest predictors of SM and MI service receipt by comparing the predictive strength of random forest and logistic regression models. Results indicate a high prevalence of self-reported need for SM (13%) and MI (34%) services among caregivers. Nearly one-quarter (23.5%) of caregivers with SM needs and 34% of caregivers with MI needs did not receive needed services. Frequent contact with CPS workers, adverse experiences in adulthood, and court involvement were strong predictors of both SM and MI service uptake. Findings suggest the need for consistent screening for SM and MI among primary caregivers at the early stages of CPS-involvement, as well as enhanced referral practices. Machine learning applications for applied social science researchers are also discussed.

Evaluating the dissociation between drivers’ self-perceived and objective need for vehicle assistance during obstacle avoidance tasks

Driver-assistance systems are becoming more commonplace; however, the realized safety benefits of these technologies depend on whether a person accepts and adopts automated driving aids. One challenge to adoption could be a preference-performance dissociation (PPD), which is a mismatch between a self-perceived desire and an objective need for assistance. Research has reported PPD in driving but has not extensively leveraged driving performance data to confirm its existence. Thus, the goal of this study was to compare drivers’ self-reported need for vehicle assistance to their objective driving performance. Twenty-one participants drove on a simulated road and traversed challenging, real-world roadway obstacles. Afterwards, they were asked about their preference for automated vehicle assistance (e.g., steering and braking) during their drive. Overall, some participants exhibited PPD that included both over- and underestimating their need for a particular type of automated assistance. Findings can be used to develop shared control and adaptive automation strategies tailored to particular users and contexts across various safety-critical environments.

Transmission of Basic Psychological Need Satisfaction Between Parents and Adolescents: The Critical Role of Parental Perceptions

Although studies have documented the importance of basic psychological need satisfaction in parent–child relationships, a gap remains in understanding how parent and adolescent need satisfaction are associated. Using two longitudinal intergenerational data sets (200 parent–adolescent dyads and 408 mother–adolescent dyads; two waves), we examined whether (a) parents’ need satisfaction predicts adolescents’ need satisfaction (parental needs effect), (b) adolescents’ need satisfaction predicts parents’ need satisfaction (child’s needs effect), and (c) parental perception of adolescent’s need satisfaction predicts adolescents’ need satisfaction (parental perception effect). Findings from cross-lagged path models analogous to actor–partner interdependence models only supported parental perception effects: Parents’ T1 perception of their adolescent’s need satisfaction predicted their adolescent’s T2 self-reported need satisfaction, especially for autonomy and competence needs. Findings highlight the importance of parents’ perceptions, which may benefit the design of new interventions for basic psychological needs.

How and when need for cognitive closure impacts attitudes towards women managers (Cómo y cuándo la necesidad de cierre influye en las actitudes hacia las mujeres directivas)

ABSTRACT In recent decades, a new line of research has found associations between specific individual differences with prejudice against female leaders. In three studies collected in Italy with heterogeneous samples (Total N = 391), we investigated the relationship between self-reported need for cognitive closure (NCC) and attitudes towards women as managers. In Study 1a we used a sample of Italian students and hypothesized that higher NCC is associated with more negative attitudes towards women managers and that this relationship is mediated by benevolence, but not by hostility, towards men. In Study 1b we used a sample of Italian employees and hypothesized that employees with higher NCC had less (vs. more) negative attitudes towards women managers when they had a female (vs. male) superior. In Study 2 we tested the model including both mediators and moderator from the previous two preliminary studies on a sample of Italian employees. The findings support the hypotheses. Our work increases knowledge about the individual-level antecedents of prejudice against women managers, as well as the conditions under which it can be reduced.

Patterns and barriers of mental health service utilization among medical students: a cross-sectional study

BackgroundThe prevalence of mental health problems among medical students has been steadily rising. It is greater than the prevalence of mental health problems among other students, negatively impacting students, and their future careers. The study aims to estimate the prevalence of the self-reported need for mental health care, the pattern of utilization of mental health services, and the different barriers that hinder medical students from seeking professional help.ResultsThis study was conducted among medical students at Mansoura University, using a structured self-reported online questionnaire to collect the need for mental health services, sociodemographic details, the pattern of utilization of mental health services, and the barriers using a Likert scale of 30 items named Barriers to Access to Care Evaluation Version 3. According to this study, 77.77% felt the need for mental health care. The independent predictors for feeling the need for mental health care were female sex and urban residence with an adjusted odds ratio of 2.7 and 1.9, respectively. Regarding mental healthcare needs, most of the barriers were instrumental and attitudinal related. Lack of information about how to access services and solve the problem by themselves was the most common barriers followed by time and financial affords.ConclusionsIt appears that Mansoura medical students are at higher risk of feeling the need for mental care. Considerable barriers to help-seeking remain prevalent, including both logistical (e.g., time) and informational (e.g., lack of knowledge about the available services).

Vitamin D supplements and prevalent overactive bladder in women from midlife through older ages.

The objective of this study is to determine if vitamin D supplementation is associated with prevalent overactive bladder (OAB) in women across the aging spectrum. We used the Nurses' Health Study (NHS) I (initiated in 1976) and NHS II (initiated in 1989) cohorts to evaluate the association of vitamin D supplements with prevalent OAB, all of which were reported by participants in 2019 in both NHS cohorts. OAB was defined as the self-reported need to rush to toilet to urinate at least sometimes. Further, OAB/wet included incontinence at least monthly because of urgency, whereas OAB/dry included incontinence once per month or less, or stress-predominant incontinence. Multivariable-adjusted odds ratios and 95% confidence intervals of OAB/dry and OAB/wet subtypes were estimated using logistic regression models. Among the 75,316 women (age range, 55-98 y) from NHS and NHS II OAB prevalence was 26%. Increasing prevalence was observed across each older age group, with 41% of women 85 years or older reporting OAB symptoms. OAB/dry was more common (18%) than OAB/wet (8%). After multivariable adjustment, no clinically significant association between vitamin D supplementation and prevalent OAB or OAB type was observed. OAB symptoms are highly prevalent across adult women, including the oldest old, who are often excluded from treatment trials. Despite interest in vitamin D supplementation as a low-cost strategy to address OAB, our findings indicate oral vitamin D is not associated with prevalent OAB in middle-aged and older women.

Who Gets Help? A National Longitudinal Study of Personal Networks and Pandemic Support Among Older Adults.

ObjectivesPersonal networks provide social support for older adults, perhaps especially during the COVID-19 pandemic when traditional avenues may be disrupted. We provide one of the first population-based studies on how pre-pandemic personal networks predict support during the pandemic among older adults, with attention to gender and race variation.MethodWe analyzed longitudinal data from the National Social Life, Health, and Aging Project Round 3 (2015/16) and COVID-19 Round (2020) (N=2622, 55.68% female, 78.75% white, aged 50-99), a nationally representative survey of community-dwelling older Americans. We considered structure (i.e., size, density) and composition (i.e., proportion female and kin) of pre-pandemic personal networks, estimating multinomial logistic models to predict self-reported need and receipt of instrumental help and emotional support during the pandemic.ResultsLarger pre-pandemic confidant networks predicted higher risk of receiving needed pandemic help and support, higher risk of receiving help and support more often than pre-pandemic, and lower risk of being unable to get help. Denser pre-pandemic networks also predicted higher risk of receiving pandemic help and support. Furthermore, how network size and density related to support differed with respondent race, and a greater proportion of kin in pre-pandemic networks predicted higher risk of receiving help for non-white older adults only.DiscussionOlder adults’ pre-pandemic confidant network structure and composition can provide underlying conditions for receiving pandemic social support. Findings speak to policies and programs that aim to foster social support or identify vulnerable groups that suffer the greatest unmet need for support during a global crisis.

Virtual Care Prior to and During COVID-19: Cross-sectional Survey of Rural and Urban Adults.

BackgroundTo reduce person-to-person contact, the COVID-19 pandemic has driven a massive shift to virtual care. Defined as the use of technology (synchronous or asynchronous) to support communication between health care providers and patients, rural-urban differences in virtual care are relatively unexplored.ObjectiveThe 2-fold purpose of this study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs.MethodsThis study was a cross-sectional online survey exploring virtual care among rural and urban adults in summer 2021 using a combination of fixed and open-ended response options. Quantitative data were analyzed using both descriptive and inferential statistics, and qualitative data were analyzed using inductive thematic content analysis.ResultsOverall, 501 (373, 74.4% female; age range 19-86 years; 237, 47.3% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (171/237, 72.2%) and urban (188/264, 71.2%) participants, with over one-half (279/501, 55.7%) reporting having only started to use virtual care since the pandemic. The self-reported need for mental health programs and services increased during the pandemic, compared with prior for both rural and urban participants. Among virtual care users, interest in its continuation was high. Our analysis also shows that internet quality (all P<.05) and eHealth literacy (all P<.001) were positively associated with participants’ perceptions of virtual care usefulness, ease of use, and satisfaction, with no rural-urban differences. Rural participants were less likely to have used video in communicating with doctors or health care providers, compared with urban participants (P<.001). When describing unmet needs, participants described a (1) lack of access to care, (2) limited health promotion and prevention options, and (3) lack of mental health service options.ConclusionsThe increased demand for and use of virtual care may reflect increased availability and a lack of alternatives due to limited in-person services during the COVID-19 pandemic, so a balance between virtual care and in-person care is important to consider postpandemic. Further, ensuring availability of high-speed internet and education to support patients will be important for providing accessible and effective virtual care, especially for rural residents.

Fear of Childbirth in Nulliparous Women.

PurposeThe relation between fear of childbirth (FoC) and gestational age is inconclusive, and self-reported need for help regarding this fear has never been investigated. This study aimed to determine the prevalence and course of FoC according to gestational age, to identify risk factors for the development of FoC, the influence of this fear on preferred mode of delivery, and self-reported need for help.MethodsNulliparous pregnant women of all gestational ages completed an online survey. The study consisted of a cross-sectional and a longitudinal analysis. Women who completed the survey in the first or second trimester (T0) were approached again in their third trimester (T1). The Wijma Delivery Expectancy Questionnaire Version A (W-DEQ A) was used with a cut-off score ≥ 85 to define presence of fear of childbirth. Questionnaires indexing social support, anxiety, symptoms of depression, preferred mode of delivery, and self-reported need for help were included.ResultsIn total, 364 women were enrolled at T0, and 118 out of 184 eligible women were included in the longitudinal analysis. Point prevalence of FoC at T0 was 18.4% with no significant difference between trimesters. In the longitudinal sample, the prevalence of FoC decreased from 18.6% (T0) to 11.0% (T1), p = 0.004. Although mean scores for FoC decreased significantly, p < 0.001, scores increased in 41 (34.7%) women. The presence of FoC was associated with elevated anxiety, less family support, prenatal care of the obstetrician by choice, preference for a cesarean section, and for pain relief. Women with FoC were more likely to actively seek for help compared to women without FoC.ConclusionWhile FoC is common in each trimester, prevalence decreases over the course of pregnancy. Women with FoC are often actively seeking for help, suggesting that this fear should be addressed better, and help should be offered accordingly.

Achievement motivation in students' everyday lives: Its relationship to momentary positive and negative activation and the moderating role of mindfulness

In achievement motive theory, need for achievement is conceptualized as an explanatory variable that triggers certain experiences and behaviors spontaneously. Experience sampling should therefore be an ideal approach for capturing such motive-specific affective contingencies. However, given that not all students seem to be aware of their underlying motives, the link between self-reported need for achievement and daily experiences may depend on their mindfulness level. In a sample of university students (N = 107), self-reported fear of failure predicted momentary negative activation across activity contexts in everyday life. In addition, hope of success predicted positive activation in more mindful students and in nonroutine situations (e.g., studying, working, or leisure time). Together, these findings are a first step toward illuminating the phenomenological and excitatory nature of need for achievement in students' everyday lives and illustrate the necessity of noticing motive-specific cues in order to integrate them into the explicit motivational self-concept.

Estimating a Model for Mental Healthcare Utilization Using Subjective Unmet Need and Psychological Distress Measures.

The objective of this study is to assess the predictive value of self-reported need and psychological distress in mental healthcare service use across racial and ethnic groups in California. Using 2014-2018 data for adults aged 18-64 in the California Health Interview Survey, both logistic and Poisson regression models are used to estimate mental healthcare utilization. Patient-reported outcome measures, such as psychological distress, are commonly used to evaluate healthcare utilization patterns. The Kessler-6 screener for psychological distress is frequently used as a tool for determining whether someone's level of distress necessitates evaluation by a mental healthcare professional. Serious psychological distress has been widely studied as a predictor of higher healthcare expenditures and use; however, moderate distress and self-reported need has been less examined in the literature. Seventy-two percent of individuals with moderate psychological distress felt like they needed to see a professional for their mental or emotional needs compared to 4% of individuals with serious psychological distress. Individuals with moderate psychological distress had 34% of all healthcare visits for mental or emotional needs during the study period, compared to 17% for those with serious psychological distress. Subjective unmet need for mental healthcare was reported by 77% of those who utilized mental healthcare during the study period. Studying subjective unmet need, in addition to moderate and serious distress, provides additional understanding of the need for mental healthcare and mental healthcare utilization.

Socioeconomic inequalities in the utilization of dental services among adults in Saudi Arabia

BackgroundThis study used the Anderson Behavioral Model to assess the socioeconomic inequalities in dental services utilization among adults in Saudi Arabia, along with other predictors of utilization, to inform future planning of dental care services.MethodsThis cross-sectional study was a secondary analysis using national data from the 2019 Kingdom of Saudi Arabia World Health Survey (KSAWHS). The survey consisted of two interviewer-administered questionnaires: one household and one individual interview. The questions covered predisposing factors (age, gender, marital status, nationality, education, employment), enabling factors (income, household wealth, area-based socioeconomic class, health insurance, eligibility for free governmental health care, transportation and region of residence) and self-reported need for dental treatment. The main outcome was dental utilization in the past year; predisposing, enabling and need factors were independent variables. Hierarchical logistic regression analyses identified significant predictors of dental utilization, applying survey weights to adjust for the complex survey design. Adjusted odds ratios with 95% confidence intervals and p values were reported in the final model.ResultsThe final dataset included 8535 adults (response rate = 95.4%). Twenty percent of adults had visited the dentist at least once in the past year (95% CI 18–21%). There were socioeconomic inequalities in dental utilization. High household income (OR 1.43, p = 0.043), second and middle household wealth status (OR 1.51, p = 0.003 and OR 1.57, p = 0.006) and access to free governmental health care (OR 2.05, p = 0.004) were significant predictors in the final regression model along with perceived need for dental treatment (OR 52.09, p < 0.001).ConclusionSocioeconomic inequalities in the utilization of dental services exist in Saudi Arabia. The need for treatment was the strongest predictor suggesting predominantly symptomatic attendance. Increasing awareness about the importance of preventive dental visits rather than symptomatic attendance could be an important policy implication to improve oral health and optimize dental care expenditure. Further research should explore the drivers for adults to seek preventive care in the absence of any recognized dental problems.