Service Attendance Research Articles

623-P: COVID-Impact on Type 2 Diabetes Self-Management during the Pandemic

Introduction: Persons with diabetes and COVID-have higher rates of morbidity and mortality than those without diabetes. Engagement in Diabetes Self-Management Education and Support (DSMES) services may improve diabetes self-management adherence. The purpose of this study was to determine whether COVID-impact and attendance of DSMES services were predictors of diabetes self-management among individuals with T2D during the pandemic. Methods: Participants (N=86) of this cross-sectional survey study were adults with T2D who either had (n=29) or had not (n=57) previously attended at least one DSMES class. The Coronavirus Impact Scale (range 0-24) was used to measure impact of the pandemic on daily life. The Self-Management Profile for Type 2 Diabetes was used to measure overall self-management and subscales for adherence, ease, coping, and importance. Multiple linear regressions were conducted to determine whether COVID-impact and DSMES participation predicted self-management total scores or subscale scores, controlling for age, sex, marital status, financial status, and time since diabetes diagnosis, with separate models for each predictor. Results: Participants were 57±12.3 years; 50% female, and 90% non-Hispanic White. DSMES attendance did not significantly predict subscale or overall scores for self-management. Higher COVID-impact predicted worse self-management adherence (F 3.71, p=0.002) , greater self-management ease (F 3.72, p=0.002) , decreased coping (F 4.65, p<0.001) , and worse overall self-management (F 4.93, p<0.001) . Neither COVID-impact nor DSMES attendance predicted self-management importance (p=0.79 and 0.99, respectively) . Conclusions: Findings underscore the negative impact of the COVID-pandemic on diabetes self-management and highlight the need for interventions to improve self-management practices during times of crisis. Disclosure L.Koonmen: None. T.A.Lennie: None. M.Ickes: None. L.B.Hieronymus: None. J.L.Miller: None. G.Mudd-martin: None. Funding Jonas Nurse Scholars Program, University of Kentucky College of Nursing PhD Dissertation Research Award

Religiosity of Baby-Boomers in Young Adulthood: Associations with Psychological Well-Being over the Life Course.

Although several studies have discovered positive relationships between religion and various aspects of mental health, less is known about longitudinal associations between religiosity and psychological well-being over the life course. We examined how religious latent classes during the transition to adulthood are associated with trajectories of psychological well-being over 45 years. We selected 798 young-adults baby-boomers from the 1971 wave of the Longitudinal Study of Generation (mean age: 19 years) and tracked their psychological well-being over nine waves up to the 2016 wave (mean age: 64 years). Latent class analysis focused on four religiosity domains (religious service attendance, religious intensity, civic value of religion, literal beliefs) identified four distinct latent religious classes: strongly religious, weakly religious, liberally religious, and privately religious. Results of latent growth curve modeling showed that strongly religious baby-boomers during the transition to adulthood generally reported better psychological well-being than weakly religious baby-boomers at the same stage in life. In addition, psychological well-being in strongly, liberally, and privately religious baby-boomers followed a consistently upward trend across the life course, whereas among weakly religious baby-boomers psychological well-being followed an inverted u-curve (increased until mid-40s and decreased thereafter). Findings suggest that earlier religiosity may serve as a significant predictor affecting psychological well-being throughout the adult life course.

The Associations between Religion, Impulsivity, and Externalizing Behaviors in the Adolescent Brain Cognitive Development (ABCD) Study

ABSTRACT In studies of adolescents and adults, religiosity has been identified as a protective factor for impulsivity-related behaviors and externalizing problems. No known studies to date have examined the relationship between religiosity and such outcomes in children. Thus, the current study examined in children whether (1) religion is associated with decreased impulsivity and externalizing symptoms, and if (2) religiosity is a protective factor in the association between impulsivity and externalizing symptoms. Data were from Wave 1 of the Adolescent Brain Cognitive Development (ABCD) study (children aged 9–10, N = 11,875). Two self-report measures and the Cash Choice Task assessed impulsivity; the Child Behavior Checklist assessed externalizing symptoms; and child religiosity was assessed in parent interviews. Structural equation models examined religiosity (affiliation, service attendance, importance) as a moderator between impulsivity and externalizing symptoms. Greater religious attendance was significantly associated with decreased impulsivity. Christian affiliation was associated with increased impulsivity as compared to other religions. Contrary to our hypotheses, religiosity did not moderate associations between impulsivity and externalizing symptoms. Findings suggest that impulsivity and externalizing behaviors are related to some domains of religiosity in children; however, the magnitude of the effect sizes was small, suggesting religiosity is not a particularly salient predictor of externalizing problems in children. Given these findings differ from those seen in studies of adolescents and adults, future studies should consider longitudinal designs to better understand how these relationships form across the lifespan.

Restricted Mourning: Impact of the COVID-19 Pandemic on Funeral Services, Grief Rituals, and Prolonged Grief Symptoms.

BackgroundThe COVID-19 pandemic has put various restrictions on grief rituals. Literature suggests that the restrictions on funerals and grief rituals may increase the chance of developing symptoms of prolonged grief (PG). In this study, we explored the possible impact of the pandemic on aspects of the funeral and grief rituals and examined their relationship with PG symptoms.MethodBereaved individuals from different countries, who lost a loved one in the year prior to the pandemic (n = 50) or during the pandemic (n = 182), filled in an online questionnaire, including a rating of the impact of COVID-19 restrictions, five aspects of the funeral service, five aspects of grief rituals, and a measurement for PG symptoms.ResultsParticipants bereaved during the pandemic rated the impact of the restrictions on the experience of the funeral and grief rituals as negative. Nevertheless, no differences were found in attendance and evaluation of the funeral and grief rituals for people bereaved prior to vs. during the pandemic. Attendance and evaluation of the funeral services were related to levels of PG symptoms, whereas the performance and helpfulness of grief rituals were not related to these symptoms. Although not related to PG symptoms, half of the participants used helpful alternative rituals to cope with their loss.DiscussionOur study suggests that bereaved people respond resiliently to the COVID-19 pandemic, for example by creating alternative rituals to cope with their loss. Furthermore, it stresses the importance of looking beyond symptom levels when studying the importance of funeral and grief rituals.

0434 The Relationship between Spirituality and Insomnia in Military Soldiers

Abstract Introduction Insomnia is prevalent among military soldiers and contributes to poor physical and mental health outcomes. Spirituality has been found to mitigate mental and physical health complaints; however, there is a dearth of research on its relationship with insomnia, particularly among military soldiers. Therefore, this study examined the associations between spirituality, religiosity, and insomnia in a sample of Army soldiers. Methods Data were acquired from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21,449; mean age= 28.6; 88.24% male). Participants completed the Brief Insomnia Questionnaire, and current insomnia status was determined by DSM-5 criteria. They also completed questions on religious affiliation, how often they attend religious services, and how religious or spiritual they consider themselves on a 4-point scale (1-Very to 4-Not at all). Chi-Square analyses were used to assess the magnitude of relationships. Results A total of 19.45% of this sample had insomnia. Self-reported religious affiliation was more common in those without insomnia (73.5%) than those with insomnia (69.9%; p<.0001). Self-reported spirituality and religiosity were associated with lower rates of insomnia (p<.0001; p<.0001). However, insomnia was associated with higher rates of regular attendance of religious services (29.8% vs. 26.0%; p<.0001). Conclusion In this sample of Army servicemembers, insomnia was less prevalent among those with a religious affiliation and those with regular attendance at religious services. In contrast, individuals with insomnia reported themselves to be less religious or spiritual compared to those without insomnia. These findings underline the importance of further research to understand whether spirituality provides any protective effects against insomnia. Support (If Any) This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981. KEM’s time was supported by the U.S Department of Veterans Affairs, Veterans Health Administration (Clinical Science Research and Development Service – IK2 CX001874). EAK’s time was supported by the U.S Department of Veterans Affairs, Rehabilitation Research and Development Service – 1IK2 RX001836.

A national study of the influence of adverse childhood experiences on depression among Black adults in the United States

BackgroundThere is a paucity of research examining the influence of adverse childhood experiences (ACEs) on depression among Black adults in the United States. This national study examined the influence of ten widely studied ACEs on past year major depressive episode (PY-MDE) among 6081 Black adults in the United States and in the context of other risk and protective factors. Other risk factors were intimate partner violence victimization, gender discrimination, and racial discrimination. Protective factors were religious service attendance and ethnic identity. MethodsData were drawn from wave two of the National Epidemiologic Survey on Alcohol and Related Conditions. ResultsResults from stratified analyses revealed that for both sexes, participants who reported any of the five types of child abuse/neglect or any of the five types of household dysfunction had greater odds of PY-MDE when controlling for other risk and protective factors. Some types of ACEs had a greater influence on PY-MDE than intimate partner violence, gender discrimination, or racial discrimination. LimitationsThis study was cross-sectional. ConclusionsFindings document the long-term effects of ACEs on PY-MDE among Black adults nationally.

Association of Psychiatric Services Referral and Attendance Following Treatment for Deliberate Self-harm With Prospective Mortality in Norwegian Patients

Psychiatric care following somatic treatment for deliberate self-harm (DSH) is pivotal in patients' lives both in the short and long term, but evidence to guide such care is limited. To examine follow-up psychiatric care for patients treated for DSH (ie, intentional self-injury or self-poisoning, irrespective of motivation) at hospital emergency departments and to assess the association of psychiatric referral and treatment attendance with risk of subsequent mortality in these patients. Retrospective data from several Norwegian registries were interlinked to follow up a national cohort of all patients with hospital-treated DSH for up to 11 years from 2008 through 2018. Data were analyzed from March to October 2021. Socioeconomic characteristics, psychiatric history, and clinical features of DSH. Referral to psychiatric services, attendance in psychiatric treatment, and prospective mortality were the 3-stage outcomes during follow-up. Logistic regression with odds ratios and cause-specific survival analysis with hazard ratios were used to examine associations between exposures and outcomes. The study identified 43 153 patients (24 286 [56.3%] female; median [IQR] age at index DSH, 39.0 [23.0-56.0] years) involving 69 569 DSH episodes. Of these patients, 6762 (15.7%) were referred to psychiatric services after somatic treatment for DSH, and 22 008 patients (51.0%) attended psychiatric treatment within 3 months of discharge following somatic treatment for DSH. Prior psychiatric history and psychiatric disorders comorbid with DSH were associated with both referral to and attendance in psychiatric care. During follow-up, 7041 patients died by suicide (n = 911) or other causes (n = 6130). While suicide risk was associated with male sex, age 35 to 64 years, and particularly prior and coexisting psychopathologies, other-cause mortality was associated with age 65 years and older and socioeconomic disadvantage. Patients with psychiatric referrals generally had an increased risk of suicide, but the risk was particularly high among patients who received a referral but did not subsequently attend psychiatric treatment (adjusted hazard ratio, 3.07; 95% CI, 2.28-4.12). The observed association was more pronounced during the first years of follow-up and in patients aged 10 to 34 years or 35 to 64 years and those with a clear intent of self-harm. This national cohort study found an association between psychiatric care attendance following treatment for DSH and prospective mortality, highlighting the importance of patient engagement in psychiatric treatment.

Effects of religion on the course of suicidality among geriatric patients with mood disorders.

A growing volume of research suggests that religion protects against late-life suicide, but it remains unclear whether effects are relevant to clinical samples, which facets of religion are most relevant, and variations over the course of mood disorders (e.g. during periods of euthymia, depression, and/or heightened suicidality). Eighty adults aged 55-85 years with mood disorders completed assessments of religion (affiliation, service attendance, importance of religion, belief and faith in God), depression, and suicidality over time (M = 7.31 measurements over M = 727 days). We computed metrics to identify mean and maximum levels of depression and suicidality, and the number of episodes of significant depression and suicidality experienced by each participant. Religious affiliation and importance of religion, but not service attendance, belief, or faith in God, were associated with lower mean and maximum depression. Conversely, all facets of religion predicted significantly lower mean and maximum levels of suicidality (rs ranging from -0.24 to -0.39), and substantially less likelihood of experiencing significant suicidality during the study (ORs ranging from 0.19 to 0.33). Service attendance, belief, and faith in God predicted less suicidality even among individuals who did not affiliate with a religious group. Religious factors, particularly faith in God, are associated with substantially less suicidality over time among older adults with mood disorders, irrespective of religious affiliation.

Medical Waste Management: An Assessment of District-Level Public Health Facilities in Bangladesh.

BackgroundDue to the huge patient load and different types of services, public health facilities produce a bulk of medical waste (MW) in Bangladesh. Improper disposal of MW increases the risk of infection among healthcare service personnel, patients, and attendants. To ensure quality services, this study aimed to assess the practices of MW management and quantify those to find out the shortcomings in the specific steps of waste management.MethodologyAs part of a larger interventional study, a facility assessment was conducted from February to April 2016 at a District Hospital (DH) and a Mother and Child Welfare Centre (MCWC) in one district. Non-participatory observation of MW management was done using a checklist that was developed following the Guideline for Medical Waste Management of Bangladesh. Scoring was applied for various activities of MW management performed in the study facilities.ResultsThe overall scores for bin management, segregation, and collection of waste were 64.5%, 58.1%, and 62.0% in DH and 53.1%, 41.5%, and 48.0% in MCWC, respectively. The performance of operation theater in MCWC was the lowest among different corners (16.7% to 36.0%). Reusable waste was segregated poorly (32% in DH and 0% in MCWC), and almost none was shredded (4% in DH and 0% in MCWC). Waste was transported from in-house to out-house temporary storage area in an open bin without any trolley or specific route. The storage area was accessible to unauthorized persons, for example, a waste picker in DH. While DH segregated 84% of its infectious waste at the source, it eventually got mixed up with other waste in the storage area and delivered to the municipality to be dumped. MCWC could segregate only 40% of its infectious waste at the source and disposed of them using the pit method. Both the facilities disposed of sharp MW by open-air burning and liquid waste through sewerage without any treatment.ConclusionsThe performance of MW management was poor in both study facilities. Advocacy to the healthcare personnel and refresher training along with supportive supervision and monitoring may improve the situation. Moreover, a larger study is needed to find out the reasons behind such poor MW management.

Religious Involvement and DSM-IV Anxiety Disorders Among African-Americans.

This study examined the relationship between eight measures of religious involvement and five anxiety disorders among a nationally representative sample of African-Americans ( N = 3403). The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition , World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime prevalence for each disorder. Logistic regression indicated weekly service attendance was inversely associated with 12-month and lifetime panic disorder, lifetime agoraphobia, and 12-month and lifetime posttraumatic stress disorder (PTSD). Prayer was inversely associated with 12-month agoraphobia, 12-month social phobia, and lifetime PTSD. Listening to religious radio and looking to God for strength were also inversely related to, respectively, 12-month and lifetime panic disorder. Conversely, reading religious materials was positively associated with 12-month panic disorder, 12-month agoraphobia, lifetime PTSD, and lifetime generalized anxiety disorder. The results are discussed in light of conceptual models that specify multiple and sometimes divergent pathways through which religion impacts health, and suggestions for clinicians addressing anxiety disorders are delineated.

Flowing Across with Demonic Hate: Belief in Supernatural Evil and Support for Stricter Immigration Policy

AbstractPrior research has found that different aspects of religion (such as service attendance and fundamentalism) have significant and varying effects on public attitudes about immigration. We identify an important but understudied aspect of how religion connects to immigration attitudes: beliefs about the reality of supernatural evil (e.g., Satan, hell, and demons). Using a national sample of Americans, we find that greater belief in supernatural evil is a strong and consistent predictor of more restrictive views of immigration, even after controlling for other dimensions of religiosity, sociodemographics, and political characteristics. Overall, beliefs about religious evil are the aspect of religion with the strongest connection to views of immigration. Consequently, consideration of religious evil is integral to understanding how religion influences public attitudes about immigration.

The Relationship Between Religious/Spiritual Beliefs and Subjective Well-Being: A Case-Based Comparative Cross-National Study

The most unique aspect of religiosity/spirituality (R/S), supernatural beliefs, and their relationship with SWB has hardly been examined. This study explores the relationship between six R/S supernatural beliefs and SWB, in a case-based comparative cross-national design including two religious and two secular nations. Data were obtained from the International Social Survey Programme (ISSP) Religion IV module from the religious countries of the USA (n = 1060) and Turkey (n = 1353) and the secular countries of Denmark (n = 1281) and Czech Republic (n = 1112). SWB was measured as happiness and self-rated health. Statistical analyses were performed using binary logistic regression models replicated across countries. Results indicated that the American sample showed no evidence of relationships between R/S and SWB outcomes capable of improving the model over demographic and service attendance covariates. In Turkey, some R/S beliefs were found to be statistically significantly related to SWB, with positive and negative associations with happiness. No associations were found in the secular countries. Findings were discussed in the light of previous research and interpreted from a terror management theory perspective.

Somatization in Adolescents With Persistent Symptoms After Concussion: A Retrospective Chart Review.

After concussion, approximately 30% of adolescents experience symptoms that persist beyond 1 month postinjury. For some, these symptoms affect functioning, development, and quality of life. Somatization, where psychological distress contributes to physical symptoms, may contribute to persistent symptoms after concussion in some adolescents. Understanding how clinicians identify somatization in adolescents with persistent symptoms after concussion in practice is a critical next step in improving our understanding, identification, and subsequent treatment of somatization in this patient population. To address this, the investigators assessed and compared characteristics of adolescents with persistent symptoms after concussion with and without clinician-identified somatization. Participants were adolescents (N=94) referred for persistent symptoms after concussion to a specialty youth concussion clinic between January 2016 and May 2018. A retrospective chart review extracted demographic and injury characteristics, symptoms after concussion, school attendance, premorbid experiences, mental health, and medical service use. Participants with physician-identified somatization were compared with those without physician-identified somatization on these measures. Adolescents with identified somatization had more severe and atypical neurological and psychiatric symptoms after concussion and more postinjury impairment in school attendance, were more likely to have a history of premorbid chronic pain or medically unexplained symptoms, and obtained more neuroimaging and health care after injury compared with those unaffected by somatization. They did not differ in mood or anxiety symptom self-reports. This study identified characteristic differences and similarities in adolescents with and without clinician-identified somatization after a prolonged concussion recovery. These findings have the potential to improve clinical identification of somatization in youths following a concussion and may aid in treatment among this demographic group.

Religious Involvement and Sleep Among Older African Americans.

Objective: This study sought to determine whether religious involvement is associated with sleep quality in a nationally representative sample of older African Americans. Methods: The analytic sample included African American respondents aged 55+ from the National Survey of American Life-Reinterview (N = 459). Religious involvement variables included service attendance, reading religious texts, watching religious television programs, listening to religious radio programs, prayer, and subjective religiosity. Sleep outcomes were restless sleep and sleep satisfaction. Multiple linear regression analysis was used. Results: Watching religious television programs was associated with more restless sleep. Respondents who attended religious services less than once a year, at least once a week, or nearly every day reported greater sleep satisfaction than respondents who never attended religious services. Subjective religiosity was associated with lower sleep satisfaction. Discussion: The findings demonstrate the importance of examining a variety of religious involvement domains, which could point to different explanatory pathways between religious involvement and sleep.

Associations of Changes in Religiosity With Flourishing During the COVID-19 Pandemic: A Study of Faith Communities in the United States.

This study explored the extent to which perceived changes in religiosity from before to during the COVID-19 pandemic are associated with flourishing. Participants from a diverse set of faith communities in two United States metropolitan regions (N = 1,480) completed an online survey between October and December 2020. The survey included items capturing perceived changes in four dimensions of religiosity (i.e., importance of religion, frequency of prayer, frequency of religious service attendance, and sense of connectedness to one’s faith community) and a multidimensional measure of flourishing. Based on multilevel regressions, results indicated that self-reported decreases in each dimension of religiosity were associated with lower overall flourishing. This pattern of findings was largely similar for the domains of flourishing, with some variation in the strength of associations that emerged. An increase in frequency of religious service attendance was associated with lower overall flourishing and lower scores on selected domains of flourishing (e.g., mental and physical health), indicating possible evidence of religious coping. Faith communities might have to find ways of supporting members during the challenging COVID-19 period to prevent long-term declines in flourishing.

Commentary: Infant Mortality Among African Americans, Using Life Course Perspective to Encourage Transformation.

Commentary: Infant Mortality Among African Americans, Using Life Course Perspective to Encourage Transformation.

FAMILY RELIGIOUSNESS, PEER RELIGIOUSNESS, AND RELIGIOUS COMMUNITY SUPPORTIVENESS AS DEVELOPMENTAL CONTEXTS OF ADOLESCENT AND YOUNG ADULT RELIGIOUS DEIDENTIFICATION

The purpose of the present study, grounded in relational developmental systems theory, was to use longitudinal data to examine the roles of individual, family, peer, and religious community predictors of religious deidentification in adolescence and young adulthood. The sample included 2,842 youth (ages 13–17) who identified with a religion at the baseline wave of the National Study of Youth and Religion (NSYR). First, Wave 1 individual (worship service attendance, youth group attendance, religious importance, prayer, and doubt), family (parent worship service attendance, parent religious importance, and family religious conversations), peer (number of religious friends, number of friends attending religious youth groups, and friend religious conversations), and religious community (engagement and dialogue) predictors were identified that significantly predicted deidentification by Waves 2 or 3. Second, when comparing Wave 1 individual, family, peer, and religious community scale scores as predictors of Wave 3 deidentification, only individual and family religiousness were significant. Third, we tested a mediation model whereby Wave 2 individual religiousness mediated relations between Wave 1 family, peer, and religious community scale scores and Wave 3 deidentification. All three indirect paths were significant, with the largest effect for family. Thus, individual, family, peer, and religious community factors all play a role in religious deidentification, but the family may be the most salient developmental context of religious development.

Perceived availability and carriage of take-home naloxone and factors associated with carriage among people who inject drugs in England, Wales and Northern Ireland.

In 2019-2020, record-high numbers of overdoses have been reported across the UK. We estimated perceived availability to and carriage of naloxone and explored factors associated with carriage among people who inject drugs (PWID) engaged with services in England, Wales, and Northern Ireland. Participants were PWID enrolled in the Unlinked Anonymous Monitoring Survey in 2019 who reported past-year injection drug use (n=2,139). Recruitment occurred through specialist and community drug agencies located across the UK, excluding Scotland. Socio-demographic, behavioural and service use characteristics were self-reported. Participants were asked whether they carry naloxone (timeframe unspecified). If they answered "no", they were further asked whether it is available in their area. Perceived naloxone availability and carriage were estimated by requirement region, classified using the Nomenclature of Territorial Units for Statistics 1. We used the Gelberg-Andersen Model of healthcare access to explore predisposing, enabling and need factors associated with regionally-aggregated naloxone carriage. Perceived naloxone availability was ≥95% in all 11 regions; naloxone carriage varied (mean: 61.1; range: 48%-71%; P<0.01). Among predisposing factors, female gender (adjusted odds ratio (AOR): 1.52; 95% confidence interval (CI): 1.21-1.91) was positively associated with naloxone carriage, whilst recruitment in Yorkshire and the Humber-relative to London-was negatively associated (AOR: 0.55; 95%CI: 0.37-0.82). Among enabling factors, past-year contact with needle and syringe programmes (AOR: 1.74; 95%CI: 1.39-2.18) and currently receiving treatment for drug use (AOR: 1.75; 95%CI: 1.24-2.46) were positively associated with naloxone carriage. Among need characteristics, past-month heroin injection, with or without past-month high-risk drinking or benzodiazepine use, was positively associated with carriage relative to no heroin injection (range of AORs: 1.71-2.58). Perceived naloxone availability is very high among PWID attending services in England, Wales, and Northern Ireland. Naloxone carriage is moderately high and varying across regions, and appears improved through recent engagement with harm-reduction programs.

Analysis of room attendant service quality in increasing customer satisfaction at Hotel Vila Lumbung

This study discusses the analysis of the service quality of room attendants in increasing customer satisfaction at Hotel Vila Lumbung. The purpose of this study is to determine the level of guests’ satisfaction with the services provided by the room attendant and determine the service indicators that need to be improved and maintained by the room attendant at this hotel. The sample is 80 respondents. This study uses a sampling technique that is incidental random sampling. The analysis technique used is SERVQUAL analysis (Service Quality) and Importance Performance Analysis (IPA). The result shows there are sixteen indicators found in the five dimensions of the service quality that show the room attendants’ performance are already categorized as excellent in terms of such dimensions as tangibility, reliability, assurance, and empathy. This indicates that there is only one dimension which service is still need to improve and maintain to make customer satisfied, namely the responsiveness dimension found in quadrant A in IPA.

Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind

BackgroundSeveral studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being.MethodsThis study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe.ResultsOverall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55–3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08–0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03–1.90)] and richest households [OR: 2.36 (CI: 1.39–3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (− 0.10)].ConclusionDecomposition analysis showed household wealth, husband’s education, women’s education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality.