Access To Services Research Articles

Experiences of central child health services teams regarding a special governmental investment in child health services

BackgroundHistorically marked by a high infant mortality rate, Sweden’s healthcare reforms have successively led to a robust, decentralized universal child health system covering over 97% of the population 0–5 years. However, inequities in health have become an increasing problem and the public health law explicitly states that health inequities should be reduced, resulting in various government initiatives. This study examines the experiences of Central Child Health Services (CCHS) teams during the implementation of the Child Health Services Accessibility Agreement between the State and the regions starting in 2017. The agreement aimed to enhance child health service accessibility, especially in socio-economically disadvantaged areas, but broadly stated guidelines and the short-term nature of funding have raised questions about its effectiveness. The aim of this study was to understand the experiences of CCHC teams in implementing the Child Health Services Accessibility Agreement, focusing on investment decisions, implementation efforts, as well as facilitators and barriers to using the funds effectively.MethodsCCHC teams were purposefully sampled and invited via email for interviews, with follow-ups for non-respondents. Conducted from January to October 2023, the interviews were held digitally and recorded with individuals familiar with the agreement’s implementation within these teams. Both authors analyzed the transcripts thematically, applying Braun and Clarke’s framework. Participants represented a cross-section of Sweden’s varied healthcare regions.ResultsThree main themes emerged from the thematic analysis: “Easy come, easy go,” highlighting funding uncertainties; “What are we supposed to do?” expressing dilemmas over project prioritization and partner collaboration; and “Building castles on sand,” focusing on the challenges of staff retention and foundational program stability. Respective subthemes addressed issues like fund allocation timing, strategic decision-making, and the practical difficulties of implementing extended home visiting programs, particularly in collaboration with social services.ConclusionsThis study uncovered the challenges faced in implementing the Child Health Services Accessibility Agreement across different regions in Sweden. These obstacles underline the need for precise guidelines regarding the use of funds, stable financing for long-term project sustainability, and strong foundational support to ensure effective interprofessional collaboration and infrastructure development for equitable service delivery in child health services.

Systematic Assessment of Family Service Barriers to Support Youth Engagement with Health and Social Care

Family characteristics and service barriers influence children’s access to health and social care. Systematic assessment of family service barriers may help practitioners in their efforts to support family engagement with needed services. To address this need, this study utilized data from a 12-week service navigation intervention to examine associations between family characteristics, service barriers, service need, and service access. Twenty-nine caregivers of youth under age 18 participated. Pre-test measures included a family demographic questionnaire, service barriers checklist, and family service plan. Post-test outcome measures were the type and number of services accessed in the family service plan. At baseline, participants reported an average of 10 barriers to care. The family characteristics, caregiver age, child age, and community group involvement, were associated with a greater number of service barriers. Over the course of the intervention, the service barrier “provider waitlists” was associated with an increased service access, while having a male child was associated with a decrease in service access. Results indicate families experience multiple service barriers and specific family characteristics influence service access. Systematic assessment of service barriers and consideration of family characteristics can assist practitioner efforts to support youth and family engagement with health and social care.

Accessing dental services in Slovenia: A quantitative study

This research focuses on patients’ perceptions regarding the accessibility of dental services in Slovenia across four dimensions: financial accessibility, time accessibility, geographical accessibility, and service quality. We observed how specific factors impact accessibility dimensions of dental services in Slovenia, that patients perceive important. A cross-sectional quantitative survey was conducted using proportionate stratified sampling. Data was collected through an online questionnaire, and 599 completed responses were received from patients regarding their experiences and perceptions of accessibility to dental care. A SEM (structural equation model) approach was used to examine the data. The analysis revealed that patients perceive all four dimensions of accessibility: financial, time, geographical, and service quality important and they all constitute the perception of dental accessibility. The findings of this study can assist policymakers in developing a more accessible dental health system by considering the results proposed in our model.

Spatiotemporal distribution and risk factors for patient and diagnostic delays among groups with tuberculous pleurisy: an analysis of 5-year surveillance data in eastern China.

To understand and analyze the factors relating to patient and diagnostic delays among groups with tuberculous pleurisy (TP), and its spatiotemporal distribution in Zhejiang Province. Data of all tuberculous pleurisy patients were collected from the existing Tuberculosis Information Management System. A time interval of > 2 weeks between first symptom onset and visit to the designated hospital was considered a patient delay, and a time interval of > 2 weeks between the first visit and a confirmed TP diagnosis was considered a diagnostic delay. Univariate and multivariate logistic regression analyses were used to explore factors influencing patient and diagnostic delays in patients with TP. Spatial autocorrelation and spatiotemporal scan analyses were used to identify hot spots and risk clusters, respectively. In total, 10,044 patients with TP were included. The median time and interquartile range for patients seeking medical care and diagnosis were 15 (7-30) and 1 (0-8) days, respectively. The results showed that people aged > 65 years, retirees, and residents of Jinhua, Lishui, and Quzhou were positively correlated with patient delay, whereas retreatment patients, houseworkers, unemployed people, and residents of Zhoushan or Ningbo were positively correlated with diagnostic delay. Additionally, high-risk clusters of patient delays were observed in the midwestern Zhejiang Province. The most likely clusters of TP diagnostic delays were found in southeast Zhejiang Province. In summary, patient delay of TP in Zhejiang province was shorter than for pulmonary tuberculosis in China, while the diagnostic delay had no difference. Age, city, occupation, and treatment history were related to both patient and diagnostic delays in TP. Interventions in central and western regions of Zhejiang Province should be initiated to improve the early detection of TP. Additionally, the allocation of health resources and accessibility of health services should be improved in the central and eastern regions of Zhejiang Province.

Determinants of Behavioral Intention Toward Telemedicine Services in Indonesia Post-Pandemic COVID-19

The COVID-19 pandemic has significantly disrupted daily life & accelerated the adoption of digital technologies across various sectors, including healthcare. In Indonesia, this shift has prompted the rapid development and implementation of Telemedicine services by both start-ups and established healthcare institutions. This study aims to identify the factors that influence customer intention to use Telemedicine services in the post-pandemic period, using the Unified Theory of Acceptance and Use of Technology (UTAUT2) model. The research focuses on five key variables: Price Value, Effort Expectancy, Geographical Location, Performance Expectancy, and Social Influence. Data collected from 507 respondents across Indonesia through an online questionnaire reveals that user satisfaction is critical for further use of Telemedicine services. The findings indicate that improvements in the affordability, user-friendliness, accessibility, effectiveness, and social endorsement of Telemedicine services significantly enhance user satisfaction. The study provides practical recommendations for Telemedicine providers to improve these factors, thereby increasing customer retention and adoption rates. This research contributes to the understanding and offers insights for optimizing Telemedicine services in Indonesia in the evolving post-pandemic behaviors

How the Smart Energy Can Contribute towards Achieving the Sustainable Development Goal 7

Against the backdrop of the digital technology revolution, smart energy offers significant opportunities to achieve the Energy Sustainable Development Goals (SDG7). However, the theoretical and empirical exploration of how smart energy can achieve SDG7 remains incomplete. This study investigates deeply into the influence and mechanism of smart energy on SDG7. Utilizing China’s smart energy pilot policy, it adopts the synthetic difference-in-difference method and China’s provincial data to estimate the influence of smart energy on SDG7. The results show the following: (1) Smart energy is beneficial to achieving SDG7, and smart energy promotes the realization of SDG7-1 by enhancing energy service accessibility, affordability, and reliability; SDG7-2 by enhancing the renewable energy absorption level and consumption ratio; and SDG7-3 by enabling real-time monitoring, accurate matching, and highly intelligent coordination to improve energy efficiency. (2) Among the quantitative findings, smart energy has notable implications for the SDG7, SDG7-1, and SDG7-3 indexes but has a more limited influence on the SDG7-2 index. (3) The single pilot tests indicate certain differences in effects due to the project scale and program design. Finally, this study provides a theoretical basis and empirical evidence for the region to search for a digital approach to realize SDG7 and smart energy construction planning.

Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective: This study aimed to understand the affordability, accessibility, and quality of maternal and child health services for postpartum mothers, and their impact on satisfaction. Methods: The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire. A survey was conducted among 289 mothers aged 20–49 in Feicheng City. Results: Regarding accessibility, most respondents (133) reported that travel time to healthcare services exceeded 60 minutes, while 99 respondents indicated a travel time of 16–30 minutes. The issue of affordability was highlighted, with 86.85% of participants perceiving maternal healthcare services as costly, indicating a significant financial burden. More than 50% of respondents were satisfied with two specific dimensions (P < 0.05) regarding the quality of maternal healthcare services. Conclusion: The study found that accessibility, affordability, and quality significantly affect mothers’ satisfaction with maternal health services. Future research should focus on developing more suitable service pathways for rural mothers.

Examining the dynamics of mobile banking app. Adoption during the COVID-19 pandemic: A digital shift in the crisis

Mobile banking applications (apps) have become crucial in maintaining financial services accessibility during the COVID-19 pandemic. This study leverages the Unified Theory of Acceptance and Use of Technology (UTAUT) to examine Malaysian millennials' behavioral intentions toward mobile banking app adoption, aiming to aid banks in developing targeted strategies to expand their user base. Data collection was conducted from October 2020 to February 2021 during the peak of the COVID-19 pandemic. A survey was administered to 270 respondents using convenience and snowball sampling methods. The Sequential Least Square method was used for the analysis. Our findings reveal that performance expectancy, effort expectancy, trust, and personal innovativeness significantly influence mobile banking app adoption intentions, whereas social influence and facilitating conditions do not. Demographic factors also modulate these relationships to varying degrees. These insights contribute to theoretical discussions on technology adoption and offer practical guidance for banks looking to enhance their digital service offerings in a post-pandemic landscape. This study underscores the shifts in consumer behavior triggered by the pandemic and highlights the ongoing potential for digital banking growth in Malaysia.

Optimalisasi Pelayanan Perizinan dengan Sistem Online Single Submission (OSS) dalam Mempercepat Pembangunan di Kota Bima

This study aims to evaluate the effectiveness of the Online Single Submission (OSS) system in enhancing licensing services and accelerating development in Bima City. Employing a qualitative descriptive approach, the research collected data through interviews, observations, and documentation, analyzing the implementation of OSS at the Investment and Integrated One-Stop Service Office (DPMPTSP). The results indicate that the implementation of OSS has improved the speed, accuracy, transparency, and accessibility of licensing services. The licensing process, which previously took a long time, can now be completed within a maximum of one week. Digital socialization and real-time tracking features have also improved public understanding and reduced misuse of authority. However, the effectiveness of OSS is still hindered by several challenges, such as limited staff, inadequate budget, technical disruptions, and digital divides. Technical issues like system and network disruptions, along with resistance to change, further obstruct the process. To address these challenges, improvements in technology infrastructure, competency training, and increased transparency are required. Overall, although OSS has had a positive impact, further efforts are needed to overcome existing challenges to ensure the system's optimization in supporting the acceleration of development in Bima City.

Barriers of access to primary healthcare services by National Health Insurance Fund capitated members in Uasin Gishu county, Kenya

PurposeThe study identifies provision of primary healthcare services using the capitated health model as a prerequisite for promoting positive healthcare outcomes for a country’s population. However, capitated members have continued to face challenges in accessing primary healthcare services despite enrolment in the National Health Insurance Fund (NHIF). This study sought to determine if variables such as patient knowledge of the NHIF benefit package, NHIF Premium Payment processes, selecting NHIF capitated health facilities, and NHIF Communication to citizens’ influences access to primary healthcare services.MethodA cross-sectional analytical research design was adopted. Data was collected from patients who were using NHIF cards, who were drawn from health facilities. Data was collected using a structured questionnaire where some of the questions were rated using the Likert scale to enable the generation of descriptive statistics. Data was analysed using descriptive and inferential statistics. Logistic regression was conducted to determine the relationship between the independent and the dependent variables.ResultsThe study found that four independent variables (Patient knowledge of NHIF Benefit Package, NHIF Premium Payment processes, Selecting NHIF capitated Health Facility, and NHIF Communication to citizens) were significant predictors of access to capitated healthcare services with significance values of .001, .001, .001 and .001 respectively at 95% significance level.ConclusionsThe study found that familiarity with the NHIF benefit package significantly influenced NHIF capitated members' access to primary healthcare services in Uasin Gishu County. While most members were aware of their healthcare entitlements, there's a need for increased awareness regarding access to surgical services and dependents' inclusion. Facility selection also played a crucial role, influenced by factors like freedom of choice, NHIF facility selection rules, facility appearance, and proximity to members' homes. NHIF communication positively impacted access, with effective communication channels aiding service accessibility. Premium payment processes also significantly linked with service access, influenced by factors such as payment procedures, premium awareness, payment schedules, registration waiting periods, and penalties for defaults. Overall, patient knowledge, NHIF communication, premium payment processes, and facility selection all contributed positively to NHIF capitated members' access to primary healthcare services in Uasin Gishu County.

Relationship between Attitude Toward Aging, Health Literacy, and Utilization of Healthcare Services among Older Adults in Suburban Areas in Iligan City

Background and Aim Health literacy and attitudes towards aging have become increasingly important problems, especially as they relate to health care. This study focused on exploring the relationship between attitudes toward aging, health literacy, and utilization of healthcare services among older adults.  Methods Using quantitative, descriptive-correlational design, data were collected from 150 older adults through structured questionnaires.  Results Older adults agreed that the services are being provided adequately. The study found a positive correlation between having adequate knowledge to manage health and the accessibility of healthcare services, and it also indicated that providing adequate information to the public can increase their knowledge about health services and facilities provided. Providing adequate information to the public can increase their knowledge about the health services and facilities provided.  Conclusion These results highlight the need for intervention that increases the utilization of healthcare services among older adults. The overall attitude towards aging is positive. High levels of health literacy are essential to enhance their ability to access and improve utilization of healthcare services. A positive attitude toward aging correlates to the accessibility of healthcare highlighting the importance of considering attitudes in the healthcare concept. There was a significant relationship between attitude toward aging, health literacy, and utilization of healthcare services among older adults.

Determinants of dropout from the maternal continuum of care in Ethiopia, multilevel analysis of the 2016 demographic and health survey.

Over the past two decades (2000-2020), Ethiopia achieved significant reductions in maternal and neonatal mortality, with a 72% and 44%, respectively. However, low maternal health service utilization and dropout from the maternal continuum of care remain major health system challenges. This study aimed to investigate individual and community-level determinants of dropout from the maternal continuum of care. We used the recent, 2016 Ethiopian Demographic and Health Survey (EDHS) data. In the maternal continuum of care pathway, i) less than four antenatal care (ANC) attendance, ii) subsequent dropout from skilled birth attendance (SBA) after 4 or more ANC, and iii) dropout from postnatal care (PNC) after attendance of facility delivery were the outcomes for dropout. A Multilevel logistic regression analysis of individual and community level factors (e.g., place of residence, geographical regions) were included in the model. The variation in the outcomes were presented by odds ratio (OR), 95% confidence interval and intra-cluster correlation coefficient (ICC). In the maternal continuum of care pathway higher dropouts were observed from SBA to PNC (85%) and from 4+ ANC to SBA (43.4%). Poorest wealth quantile (AOR = 2.31, 95% [CI = 1.69,3.16]), having no health insurance coverage (AOR = 1.44, 95% [CI = 1.01,2.06]), and high community poverty (AOR = 1.28, 95% [CI = 1.01,1.63]) were associated with having < 4 ANC attendance. Perceived distance from health facility as a big problem (AOR = 1.45, [95% = CI, 1.12,1.88), lower community media exposure (AOR = 1.6, 95% [CI = 1.14,2.23]) and rural residency (AOR = 3.03, 95% [CI = 1.75,5.26]) increased the odds of dropout from SBA after 4+ ANC visits. The dropout from the maternal continuum of care was higher in Ethiopia and postnatal care were the most affected maternal care. Oromia and Somali regions were associated with dropouts from all levels of care. Policy strategies should prioritize geopolitical regions with higher dropout levels. In addition to improving access and quality of institutional health services, designing an alternative strategy for targeted outreach for ANC visits and postnatal checkups is recommended.

Анализ заболеваемости глаукомой населения регионов Черноземья за 2014–2021 годы.

The aim of the study is to analyze the dynamics of glaucoma prevalence and incidence in population of Black Earth regions in 2014–2021. Materials and methods. The dynamics of glaucoma incidence and prevalence was studied by data of medical aid appealability of population of Black Earth regions. Analysis covered the period from 2014 to 2021. The study of morbidity rates was based on data from statistical digests of the Ministry of Health of the Russian Federation and Russian Research Institute of Health. Results. The research findings showed the increase in glaucoma prevalence in 2014–2021 in population of Black Earth regions in general (by 0,5%) and in the Voronezh Region (by 21,7%), the Kursk Region (by 24,9%) and the Tambov Region (by 7,1%). Two Black Earth regions showed the decrease in glaucoma prevalence – the Belgorod Region (by 7,0%) and the Lipetsk Region (by 3,7%). Glaucoma incidence rate during analyzed period is characterized by downward trend in Russia as a whole (by 22,4%), as well as in all the Black Earth regions: the Lipetsk Region by 63,4%, the Tambov Region by 32,6%, the Belgorod Region by 23,4%, the Kursk Region by 20,1%, the Voronezh Region by 1,8%. Conclusions. The increase in glaucoma prevalence and incidence in the population of Russia, the Voronezh Region, the Kursk Region, the Tambov Region indicates the accumulation of a patient population with previously diagnosed glaucoma due to increased expectation of life and decreased detection of new glaucoma cases. The decrease in glaucoma prevalence and incidence in the Belgorod Region and the Lipetsk Region indicates the decreased access of medical services for patients with ophthalmic disease in public medical establishments of these regions.

A qualitative study exploring the perinatal experiences of social stress among first- and second-generation immigrant parents in Quebec, Canada

BackgroundPerinatal psychological distress adversely impacts the well-being and social adjustment of parents and their children. Expectant parents who have migrated may be at higher risk for perinatal psychological distress due to various migration-specific stressors and healthcare service barriers. Limited studies have examined the perceived determinants of perinatal distress in immigrant parents, particularly men. This study explored first and second-generation immigrant parents’ lived experiences of social stressors and facilitators of perinatal psychological well-being.MethodsParticipants were recruited by convenience and purposive sampling as part of a larger study. Semi-structured interviews were conducted virtually with first and second-generation immigrant women and men in Quebec, Canada. An inductive thematic analysis was performed.ResultsSixteen women (age = 34.8 ± 3.7 years) and ten men (age = 35.1 ± 4.9 years) from various ethnic backgrounds participated in the study at 7.4 ± 0.73 and 7.5 ± 0.72 months postpartum, respectively. Three themes were identified: (1) cultural pressures (cultural differences in parenting, gender-related cultural pressures, health and baby-related practices), (2) health and social service access (social benefits and resources, and systemic barriers in health care), and (3) discrimination (physical appearance or parental-related discrimination, gender-related discrimination, ethnic-related discrimination). First-generation immigrant parents reported greater acculturative stress (i.e. mental health stigma, health care access) and ethnic discrimination concerns related to their distress. Among men, barriers include feeling as though the paternal role was devalued by society and not receiving consideration by health care.ConclusionsOur results highlight different social factors of perinatal well-being perceived by men and women from various ethnic and immigration backgrounds during the perinatal period. Perceived factors include macro-level factors, such as a country’s social climate, health and social policies and services, and social aspects of acculturative stress. Our findings suggest the need for continued efforts to challenge and eliminate discriminatory practices. Interventions and resources directed at first-generation immigrant parents should be bolstered. Understanding what parents perceive to facilitate or hinder their psychological well-being can help inform the development of tailored evidence-based programs and policies to better meet the mental health needs of Canadians and reduce gender disparities in the treatment of perinatal distress.

Spatial patterns of maternal and neonatal continuum of care use and its correlations with women’s empowerment

BackgroundThe continuum of care (CoC) in maternal health refers to the continuity of individual reproductive health care across the antenatal, intrapartum, and postnatal periods. The CoC is an indicator of the quality of maternal and newborn health outcomes and women’s empowerment is crucial to improving maternal and neonatal health service access and utilisation.ObjectiveTo examine the spatial patterns of continuum of care use for maternal and neonatal health services and its correlation with women’s empowerment.MethodsWe analysed data from the Ethiopian Demographic and Health Surveys (EDHS) of 2011 and 2016. All women aged 15–49 who had live births in the preceding five years of the DHS surveys were included in the analysis. We measured the continuum of care using the modified co-coverage index (CoCI), which consisted of six indicators. Women’s empowerment was assessed using a validated survey-based Women’s Empowerment (SWPER) index. We used the Getis-Ord-Gi* spatial analysis tool to portray locations with clusters of CoC service use and spatial correlations between CoC use and women empowerment.ResultsNone of the newborn-mother pairs in the 2011 survey received the entire continuum of care and only 2.5% of newborn-mother pairs received the full range of continuum of care services in the 2016 survey. In 2016, 6.9% of mother-newborn pairs received the basic CoC services (four or more antenatal care [ANC] visits, skilled birth attendance [SBA], and postnatal care [PNC]), and no mother-newborn pair received all three services at the same time in 2011. The Amhara, Afar, and Somali regional states had the least CoC service use in both surveys. There was a positive spatial correlation between CoC use and women’s empowerment domains.ConclusionOur analysis showed that the use of four or more ANC visits, SBS, newborn PNC, Bacillus Calmette-Guérin (BCG) vaccine uptake, and tetanus toxoid protection at birth were low in Ethiopia. Women empowerment domains were found to have a positive spatial correlation with CoC services use. To improve and preserve continuity of care, it is critical to leverage every maternal health facility encounter to encourage sustained service usage at each step of the continuum. Government policies should prioritise women’s empowerment and raise public awareness of maternity services.

Global comparison of urban bike-sharing accessibility across 40 cities

The global expansion of bike-sharing networks offers a cost-effective and environmentally friendly transportation alternative that complements public transit and promotes active, healthy lifestyles. Despite significant research, most studies focus on individual locations, specific environmental or health impacts, or infrastructure elements like bike lanes. Instead, this paper elaborates a comprehensive global comparison of bike-sharing systems by introducing a novel database that aggregates data from 40 cities worldwide. Our study integrates this data with population data and urban metrics to classify these networks topologically and assess their effective coverage concerning the population served and their relation with existing public transit systems. We introduce the “Bike-Share Service Accessibility Index” (BSAI), a new metric to evaluate and compare the performance of bike-sharing networks. Our findings provide valuable insights for urban planners and policymakers, offering data-driven strategies to enhance sustainable urban mobility through better-integrated and more spatially equitable bike-sharing systems.

Experiences Accessing Health and Social Services during and after Natural Disasters among People Who Use Drugs in Houston, Texas.

People who use drugs (PWUD) disproportionately experience health-related and social vulnerabilities, which may affect service needs and access during and after natural disasters. We conducted qualitative interviews with N = 18 PWUD recruited via a syringe services program in Houston, Texas. We assessed their health and social service needs, as well as related service access experiences, during and after natural disasters using a combined inductive-deductive approach. Participants described a range of service-related needs related to illicit drug use, poverty, neighborhood disadvantage, acute and chronic health problems, and housing insecurity. They endorsed decreased access to medical and substance-related services and difficulty accessing disaster relief aid. Interviews highlighted the importance of mutual aid for sharing harm reduction supplies and meeting practical needs. Results suggest that some PWUD experience disproportionate vulnerability after natural disasters related to multiple marginalized identities that intersect with illicit drug use.

Digital Public Services in Indonesia Show High Satisfaction and Adaptation Challenges Remain

General background: Public service is an essential function of government, aimed at fulfilling citizen needs through the provision of goods, services, and administrative support in accordance with regulations. Effective public service requires continuous bureaucratic reforms. Specific background: Lemujut Village, in collaboration with the Population and Civil Registration Service of Sidoarjo Regency, introduced the Online Service (Plavon) application to improve population administration and civil registration services. However, the effectiveness of the Plavon application remains underexplored. Knowledge gap: There is limited research on the effectiveness of digital public service platforms like Plavon in rural Indonesian settings, particularly in terms of productivity, efficiency, satisfaction, and adaptability. Aims: This study aims to evaluate the effectiveness of the Plavon application in improving public service quality in Lemujut Village by analyzing five key elements: productivity, efficiency, satisfaction, adaptation, and development. Results: Findings indicate that productivity is high, with Plavon operators following procedures and maintaining public trust. However, efficiency is lacking, as some administrative processes fail to meet service time standards. Community satisfaction is notably high at 98.98%, but adaptation to digital services remains suboptimal due to inadequate socialization. Development efforts, such as coordinating via WhatsApp and establishing a call center, show significant progress. Novelty: This study provides a detailed evaluation of the Plavon application’s impact on village-level public services, highlighting the role of digitalization in improving service delivery while identifying challenges in community adaptation and efficiency. Implications: The findings suggest the need for enhanced socialization of digital services and continued development of digital infrastructure to ensure equitable access and efficiency in rural public services. Highlights: High public satisfaction, but service delays persist. Digital adaptation slow due to lack of community awareness. Effective coordination boosts service improvement efforts. Keywords: Public service, digital platform, Plavon, effectiveness, rural Indonesia

From Adolescence to Adulthood: Understanding Care Trajectories in an Early Detection and Intervention Centre in France.

Psychiatric disorders often emerge during adolescence or young adulthood, leading to significant disability among youth. The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is critical for individuals experiencing emerging psychopathology, with delayed access to care negatively impacting long-term outcomes. Accessing mental health services for adolescents and young adults is often complex and delayed due to challenges in service visibility, accessibility and appropriateness. This study examines the care trajectories of individuals consecutively accessing the early detection and intervention (EDI) centre C'JAAD (Evaluation Centre for Young Adults and Adolescents) in Paris (France) over the year 2021. The main goal was to clarify the role of this EDI centre in the continuity of care and transition to AMHS. Data about their history of care, hospitalisations and referral sources were collected retrospectively. The sample comprised 194 individuals, with 57.2% males and a median age of 20 years. Most patients (67.5%) were ≥18 years old upon arrival, with 31% in a situation of not being in education, employment, or training (NEET). Over one-third (35.2%) had prior psychiatric hospitalisations. Patients were mainly referred to our EDI centre from other hospital departments (42.3%). Regarding care in CAMHS, 50.3% of the total sample had medical follow-up during childhood, of whom 41.9% had discontinued care upon arrival at the EDI centre. The median onset age of care in CAMHS was 14, with a median duration of 12 months. Adult patients experienced an approximately 3-year gap between the end of CAMHS care and assessment at the EDI centre. The sample's characteristics resemble those of other EDI centres, but concerns persist regarding referral timing and the NEET status of many youths. Lack of prior medical follow-up and challenges in transitioning to AMHS underscore the need to enhance care continuity and address difficulties in accessing care during the transition to adulthood.

A Unification of Fog-Cloud Computing for Data Agitation and Guard Intensification in Industrial Health Care Security

The development of Fog computing is a decentralized environment in which the data processing, storage and applications are processed between the located server in a cloud environment. By increasing the Internet of things (IoT) and remote storage, the communication in cloud become more sophisticated by processing the data safely and securely. Healthcare data is important which contains medical information and processed centrality in the public environment through IoT, due to increasing security breaches they need to protect depends on the security applicants. All over the centralized data computing are accessed by virtual environment through remote protocol doesn’t provide safety in healthcare industry. To resolve this problem, to propose as Unification of fog-cloud computing for data agitation and guard intensification (DA-GI) in Industrial Health Care Security. The Medical Data Health-Care (MDHC) records are stored in Cloud datacenters and the Fog layer based on the guard intensity and the key is provoked for ingress the file. The activity logs are controlled and monitoring from cloud serves sustains the Activity Log, Risk Table and Health Records. To introduce a cryptographic approach based on advanced encryption standards (AES) to protect data and authenticity verification server. The key verification process based on security gateway, Fog cloud server depends on user access rights provided to the user. During the key validation, role of permission to the user s verified and agitate to allow access rights to the verified service access. The proposed system produce high security compared to the other system as well in all security concerns of role, authentication and verification to process data safely.