Unmet Health Care Need Research Articles

The Association Between Victimization and Perpetration of Physical Intimate Partner Violence and Unmet Healthcare Needs Among Married Women in South Korea.

This study assessed physical intimate partner violence (IPV) experiences and examined their association with unmet healthcare needs among married women in South Korea. We analyzed data from a nationally representative longitudinal survey of 6,533 women at baseline. Participants were asked yes/no questions about their experiences of physical IPV victimization and perpetration over the past year. The responses were classified into four categories of IPV experience: "none," "victimization only," "perpetration only," and "both victimization and perpetration." At baseline, 0.9% reported being victimized only, and 25.9% reported both victimization and perpetration. The prevalence of unmet healthcare needs over the past year at baseline was 0.8%. Compared to women without any IPV experience, women in the IPV "victimization only" category had greater unmet healthcare needs (OR: 5.49, 95% CI [2.30, 13.12]) after adjusting for sociodemographic variables. Experiencing IPV perpetration only and both IPV victimization and perpetration were not statistically significantly associated with unmet healthcare needs. These results imply that physical IPV victims face difficulties accessing healthcare services which could exacerbate health inequalities over time. Moreover, this study suggests that it is necessary to distinguish IPV victims from those who experience IPV victimization only and those who experience both IPV victimization and perpetration.

Factor Influencing Unmet Healthcare Needs among the disabled

Abstract Background The unmet Healthcare needs (UHNs) of the disabled are not only detrimental to their quality of life but also can lead to serious health outcome including death. A variety of factors including socioeconomic, personal, environmental factors affect UHNs for the disabled. Methods We analyzed the UHNs status and influencing factors among 4,326 adult the disabled using Korea disability Life Data. Chi-square analysis was conducted to identify differences in UHNs according to characteristics of general, disability, environmental of the disabled. Logistic regression analysis was conducted to determine factors affecting UHNs. Results Those with low educational level (aOR=1.23, 95% CI = 1.02-1.48), those enrolled in private insurance (aOR=1.23, 95% CI = 1.02-1.50), those need help with daily living (aOR=1.30, 95% CI = 1.06-1.59), those who rarely go out (aOR=1.57, 95% CI = 1.27-1.92), those who use taxis (aOR=1.41, 95% CI = 1.05-1.89) or call taxi for the disabled when going to the hospital (aOR=1.37, 95% CI = 1.01-1.88), the communication disabled (aOR=1.30, 95% CI = 1.03-1.65), those with poor subjective health status (aOR=1.25, 95% CI = 1.04-1.49), those felt the explanation of treatment results was insufficient (aOR=4.04, 95% CI = 1.37-11.93), and those dissatisfied with healthcare services (aOR=3.52, 95% CI = 2.74-4.51) were more likely to experience UHNs. Conclusions Effective healthcare service provision for the disabled requires not only financial assistance but also social support, along with education for healthcare staff, policies with the characteristics of disabilities. Funding: This research was supported by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165) and by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. RS-2024-00394642) Key messages • The disabled need not only financial support when using healthcare services, but also support from society, such as accompanying them to the hospital and providing transportation. • Education for healthcare staff who communicate with the disabled and provision policy to provide appropriate healthcare services according to the characteristics of disabilities are needed.

Determinants of Unmet Healthcare Needs During the Final Stage of the COVID-19 Pandemic: Insights From a 21-Country Online Survey.

During the COVID-19 pandemic, essential health services experienced significant disruptions, impacting preventive and chronic care across the world. Utilizing the Pandemic Recovery Survey (PRS), conducted online with Facebook's Active User Base across 21 countries between March and May 2023, this cross-sectional study identifies the magnitude of and key factors associated with unmet preventive and chronic care needs during the late stage of the COVID-19 pandemic. Approximately 28.2% of respondents reported unmet preventive care needs, and 42.1% experienced unmet chronic care needs, with key determinants including food insecurity (aOR 1.94, 95% CI 1.81-2.07 for preventive services; aOR 1.85, 95% CI 1.68-2.03 for existing conditions) and distrust in health professionals (aOR 1.09, 95% CI 1.03-1.15 for preventive services; aOR 1.53, 95% CI 1.41-1.66 for existing conditions). The findings underscore a widespread unmet need for health services, highlighting the impact of social determinants and trust in health professionals on service disruption. The results suggest that pandemic recovery efforts should focus on the most affected groups to bridge health disparities and ensure an equitable recovery.

State Differences in Children’s Mental Health Care

ObjectivesThis study estimates and compares variation in the probability of child unmet need for mental health care and difficulties accessing care for each state in the United States. Estimates are also generated and compared for three socioeconomic and demographic subgroups nationwide: racial/ethnic group, household income, and insurance type. MethodsUsing a retrospective, cross-sectional design, this study pooled 2016-2019 National Survey of Children’s Health data. National, state, and subgroup adjusted probabilities of caregiver-reported child unmet need for mental health care and ease of access to mental health care were generated from logistic regression models with marginal post-estimation. ResultsAdjusted national probabilities of caregiver-reported child unmet mental health need and difficulty in accessing care were 0.21 and 0.46, respectively. State probabilities of unmet need ranged from 0.08 to 0.32. One state was significantly above the national estimate; nine states were below it. State probabilities of difficulty accessing mental health care ranged from 0.28 to 0.57; nine states’ probabilities were significantly below the national estimate and two states were significantly above it. Estimates of unmet mental health need and difficulty accessing care varied more widely across states than across racial or ethnic groups, income groups, insurance groups. ConclusionsGeographic inequities in children’s mental health care access persist; in some cases, they are larger than sociodemographic inequities.

The Impact of Unmet Healthcare Needs on the Perceived Health Status of Older Europeans During COVID-19.

To examine how unmet healthcare needs and the exposure to the pandemic impacted self-reported health (SRH) among individuals aged 50 and above. We use data from two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona Survey collected in 2020 and 2021 in 27 European countries and Israel (N = 42,854). Three dimensions of barriers to healthcare access were investigated: healthcare forgone, postponed, and denied. Mixed-effects logistic regression analysis was employed to explore SRH deterioration during the pandemic. Findings indicate that unmet healthcare needs decreased throughout the pandemic but significantly contributed to the worsening of SRH among older adults. Mild or severe exposure to the pandemic heightened the likelihood of reporting deteriorated SRH. Additionally, the pandemic disproportionately affected females, the oldest-old, and those living alone or facing economic vulnerability. To mitigate the adverse effects on the health status of older adults, policymakers are strongly advised to prioritize addressing the healthcare needs of those who have been disproportionately affected by the pandemic.

National Trends in the Prevalence of Unmet Health Care and Dental Care Needs During the COVID-19 Pandemic: Longitudinal Study in South Korea, 2009-2022.

Although previous studies have investigated trends in unmet health care and dental care needs, most have focused on specific groups, such as patients with chronic conditions and older adults, and have been limited by smaller data sets. This study aims to investigate the trends and relative risk factors for unmet health care and dental care needs, as well as the impact of the COVID-19 pandemic on these needs. We assessed unmet health care and dental care needs from 2009 to 2022 using data from the Korea Community Health Survey (KCHS). Our analysis included responses from 2,750,212 individuals. Unmet health care or dental care needs were defined as instances of not receiving medical or dental services deemed necessary by experts or desired by patients. From 2009 to 2022, the study included 2,700,705 individuals (1,229,671 men, 45.53%; 673,780, 24.95%, aged 19-39 years). Unmet health care needs decreased before the COVID-19 pandemic; however, during the pandemic, there was a noticeable increase (βdiff 0.10, 95% CI 0.09-0.11). Unmet dental care needs declined before the pandemic and continued to decrease during the pandemic (βdiff 0.23, 95% CI 0.22-0.24). Overall, the prevalence of unmet dental care needs was significantly higher than that for unmet health care needs. While the prevalence of unmet health care needs generally decreased over time, the β difference during the pandemic increased compared with prepandemic values. Our study is the first to analyze national unmet health care and dental care needs in South Korea using nationally representative, long-term, and large-scale data from the KCHS. We found that while unmet health care needs decreased during COVID-19, the decline was slower compared with previous periods. This suggests a need for more targeted interventions to prevent unmet health care and dental care needs.

Homeless patients requiring haemodialysis: incidence, caseload characteristics, and implications for care

Background Homelessness is a recognized risk factor for the development of kidney failure. However, the risk of requiring renal replacement therapy (RRT) in homeless populations remains unknown. Furthermore, access to and provision of RRT for homeless populations have not been described. Methods We performed a retrospective study of all patients who newly commenced in-centre haemodialysis at St. James’s Hospital, Dublin, from January 2021 to December 2023. Housing status was captured using registered addresses and a review of social workers’ assessments. Homelessness was defined according to the European Typology on Homelessness and Housing Exclusion Criteria. Using publicly available census and homelessness data, we estimated the risk of commencing haemodialysis among homeless and non-homeless populations in the catchment area. Results The overall prevalence of homelessness among adults in the catchment area was approximately 2000/270,000 (0.74%). Of the 74 patients who commenced haemodialysis over the 3-year period, 13 (17.6%) were homeless. There was a significant difference in the incidence of commencing haemodialysis between non-homeless and homeless individuals in the catchment area (p<0.001, chi-square test). Among patients who commenced haemodialysis, the mean age was 53 years in homeless patients and 62 years in non-homeless patients (p<0.05, one-way ANOVA). 3/13 homeless patients (23%) had received nephrology healthcare at least 3 months prior to haemodialysis, compared with 39/61 non-homeless patients (64%) (p <0.05, chi-square). Of the three homeless patients who had received three months of nephrology healthcare prior to haemodialysis, all three patients commenced haemodialysis via an arteriovenous fistula. Mental health comorbidities were more frequent among homeless patients than among non-homeless patients (23% versus 8%) (not statistically significant), as were substance use disorders (38% versus 7%) (p<0.05, chi-squared test). Conclusion The incidence of kidney failure requiring haemodialysis was higher in homeless adults than in their non-homeless peers. Homeless patients were younger and started haemodialysis more urgently. There is an unmet need for nephrology healthcare for the homeless population.

'There's Nothing Wrong With You; You Just Need to Lose Weight'-A Qualitative Exploration of Pelvic Floor Dysfunction Among Women With Multiple Sclerosis and Their Interaction in Seeking Pelvic Healthcare.

Within 10 years of multiple sclerosis (MS) progression, nearly all women will have experienced symptoms associated with bladder, bowel and/or sexual health. Yet despite the impact these symptoms have on physical, psychological and social well-being, it remains an underserved area within the UK healthcare system. This research employs a participatory research approach framed within the principles of intersectional feminism to collaboratively investigate the lived experiences of pelvic floor dysfunction (PFD) and healthcare interactions among UK-based women with MS. Women residing in the United Kingdom with MS were invited to participate in online interviews facilitated by the primary author. A thematic framework analysis offering a structured yet adaptable approach to data collection and interpretation. One focus group involving four women with MS and seven individual, one-to-one interviews with women with MS provided insights into the challenges associated with navigating both MS and PFD. Four main themes included: Navigating MS and PFD; Cycles of Control; Mind, Mobility and Bladder Embodiment; Silenced Voices: The Impact of Taboos/Stigma/Dismissal on Preventing Access and Resistance through Collective Community. Six subthemes were also identified. Taken together, these themes cumulatively reflect PFD as an unmet healthcare need. Our findings underscore negative healthcare experiences, inadequate information provisionand unmet needs related to PFD, emphasising the compounding effects of gender and disability biases. We hope that these insights can lay the groundwork for developing tailored therapeutic interventions and improved PFD healthcare for women with MS. Potential solutions include using existing MS support communities. Women with MS were actively involved in co-producing interview scripts for one-to-one interviews. The primary author shared study findings at an MS group event, engaging in discussions with over 30 individuals, including people with MS and their loved ones. MS advocates played a pivotal role in contextualising the study within the broader lived experience of MS.

Variations in Unmet Health Care Needs by Perceptions of Social Media Health Mis- and Disinformation, Frequency of Social Media Use, Medical Trust, and Medical Care Discrimination: Cross-Sectional Study.

Unmet need for health care is defined as choosing to postpone or completely avoid necessary medical treatment despite having a need for it, which can worsen current conditions or contribute to new health problems. The emerging infodemic can be a barrier that prevents people from accessing quality health information, contributing to lower levels of seeking medical care when needed. We evaluated the association between perceptions of health mis- and disinformation on social media and unmet need for health care. In addition, we evaluated mechanisms for this relationship, including frequency of social media use, medical trust, and medical care discrimination. Data from 3964 active adult social media users responding to the 2022 Health Information National Trends Survey 6 (HINTS 6), a nationally representative survey, were analyzed. The outcome was unmet need for medical care, defined as delaying or not getting the necessary medical care. The predictor variables were perception of social media health mis- and disinformation, frequency of social media use, level of trust in the health care system, and perceived racial and ethnic discrimination when receiving health care. Multivariable logistic regression models indicated that perception of substantial social media health mis- and disinformation (odds ratio [OR] 1.40, 95% CI 1.07-1.82), daily use of social media (OR 1.34, 95% CI 1.01-1.79), low medical trust (OR 1.46, 95% CI 1.06-2.01), and perceived discrimination (OR 2.24, 95% CI 1.44-3.50) were significantly associated with a higher likelihood of unmet need for medical care. Unmet need among adults who did not use social media daily and who did not perceive substantial mis- and disinformation (24%; 95% CI 19%-30%) was lower compared to daily social media users who perceived substantial mis- and disinformation (38%; 95% CI 32%-43%). Adults who perceived substantial mis- and disinformation and had low trust in health care had the highest probability of reporting unmet need (43%; 95% CI 38%-49%) compared to the other three groups. Adults who perceived substantial mis- and disinformation and experienced medical care discrimination had a statistically significant higher probability of reporting unmet need (51%; 95% CI 40%-62%) compared to adults who did not experience medical care discrimination and did not perceive substantial mis- and disinformation (29%; 95% CI 26%-32%). Unmet need for medical care was higher among individuals who perceived a substantial degree of social media mis- and disinformation, especially among those who used social media daily, did not trust the health care system, and experienced racial or ethnic discrimination when receiving health care. To counter the negative effects of social media mis- and disinformation on unmet need for health care, public health messaging must focus on daily social media users as well as improving trust and reducing structural racism in the health care system.

Prevalence of, and Factors Associated with, Unmet Healthcare Need in Urban Refugees and Asylum Seekers in Bangkok, Thailand: a Mediation Analysis

This study examines the prevalence of, and factors mediated to, unmet healthcare need of urban refugees and asylum seekers (URAS) in Thailand. In 2019, a cross-sectional survey of 181 URAS was merged with Thai data (total n=3,122). Self-reporting questionnaire was applied. Unmet healthcare need, defined as a status where a person needed health examination or treatment within the past 12 months, but he or she did not receive it, were analysed using multivariable logistic regression within a concept of mediation analysis. URAS were younger and had lower household economic status than Thais, and almost all URAS were uninsured. Most URAS suffered from a high prevalence of unmet healthcare need, 54.1% (range 31.4–100.0%) for outpatient (OP) care and 28.0% (range 0–83.3%) for inpatient (IP) care, while unmet healthcare need prevalence amongst Thais was 2.1% for both OP and IP care. For OP care, the direct effect of URAS status (predictor) on unmet healthcare need (outcome) showed a significant adjusted odds ratio (AOR) of 8.8 (95% CI 1.3–58.6), and a total effect (combining direct effect and indirect effect where insurance status served as a mediator) had AOR as large as 42.3 (95% CI 26.4–67.8). A significant total effect was also observed for IP care (AOR 13.1, 95% CI 7.8–22.0). Since most URAS substantially suffer from a lack of insurance coverage and this markedly influenced healthcare inaccessibility, policymakers should prioritise expanding insurance coverage towards URAS to promote health equity for all.

Factors Associated with Unmet Health Care Needs : Focusing on Socioeconomic Characteristics and Depressive Disorders among Community-dwelling Elderly

Factors Associated with Unmet Health Care Needs : Focusing on Socioeconomic Characteristics and Depressive Disorders among Community-dwelling Elderly

Exploring unmet healthcare needs and associated inequalities among middle-aged and older adults in Eastern China during the progression toward universal health coverage

BackgroundGiven the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its inequalities, but little attention has been paid to the inequality in unmet healthcare needs. This study aimed to analyze the inequalities in unmet the healthcare needs of middle-aged and older adults in eastern China during the progression toward UHC.MethodsData were obtained from the fourth, fifth, and sixth National Health Service Survey (NHSS) of Jiangsu Province, located in eastern China, during the years 2008, 2013, and 2018, respectively. Logistic regression models were used to assess the associated factors of unmet healthcare needs. The inequality was measured according to the concentration index (CI) and its decomposition.ResultsIn this study, we found that 12.86%, 2.22%, and 48.89% of middle-aged and older adults reported unmet needs for outpatient and inpatient services and physical examinations, respectively. The prevalence of unmet outpatient needs increased from 2008 to 2018, while the prevalence of unmet inpatient services was lower but maintained. The prevalence of unmet needs for physical examinations among middle-aged and older adults markedly decreased since 2008. Rural areas had a higher prevalence of unmet needs for inpatient services and physical examinations than urban areas. Unmet healthcare needs were more prevalent among the poor. The pro-poor inequalities of unmet healthcare needs have been mitigated during the progression toward UHC; however, they remain predominant among rural middle-aged and older adults for outpatient and inpatient services. Socioeconomic factors significantly influenced unmet healthcare needs and contributed to their inequalities.ConclusionsThe findings characterize the prevalence and inequality of unmet healthcare need among middle-aged and older adults in eastern China during the progression toward UHC. Policy interventions should be actively advocated to effectively mitigate the unmet healthcare needs and address the associated inequalities.

Reasons for Unmet Health Care Needs Among Black, Hispanic, and White Children in the United States With or at Risk for Physical and Mental Health Conditions.

Children with special health care needs (CSHCN)-ie, children who are at increased risk for, or currently manage, persistent physical and mental health conditions-require more health care resources than children without special health care needs. Furthermore, CSHCN who identify as racial/ethnic minorities disproportionately encounter unmet needs, according to reports from their caregivers. However, the reasons for their unmet needs are relatively unknown. This study estimated and compared the US national prevalence of caregiver-reported reasons for unmet health care needs for Hispanic, non-Hispanic black, and non-Hispanic white CSHCN. The most common reasons were problems getting an appointment for black CSHCN and cost for Hispanic and white CSHCN. Issues related to transportation were significantly less likely for black than for white and Hispanic CSHCN. Cost-related issues were significantly less likely for black than Hispanic CSHCN. To address reasons for unmet needs for CSHCN, effective structural changes are needed.

The Unmet Health Care Needs of Indigenous People Incarcerated in Tribal Jails

This Viewpoint investigates the poor quality of health care provided to Indigenous peoples incarcerated in US tribal jails and proposes solutions to address health disparities and strengthen tribal sovereignty.

Unmet need for mental health care among adolescents in Asia and Europe.

The unmet need for mental health care is a global concern. There is a lack of cross-cultural studies examining adolescent help-seeking behavior from both formal and informal sources, including both high-and lower-income countries. This study investigates mental health help-seeking behavior in eight Asian and European countries. Data from 13,184 adolescents aged 13-15 (51% girls) was analysed using mixed-effects logistic regression with school-wise random intercepts to compare countries and genders. Although a significant proportion of adolescents considered getting or sought informal help, formal help-seeking remained exceptionally low, especially in middle-income countries (< 1%), while it ranged from 2 to 7% in high-income countries. Among adolescents with high emotional and behavioral problems (scoring above the 90th percentile on the Strengths and Difficulties Questionnaire), 1-2% of those in middle-income countries and 6-25% of those in high-income countries sought formal help. Girls generally seek more help than boys. The study shows the most adolescents do not receive formal help for mental health problems. The unmet need gap is enormous, especially in lower-income countries. Informal sources of support, including relatives, peers, and teachers, play a crucial role, especially in lower-income countries.

Mental Healthcare Needs and Experiences of LGBT+ Individuals in Malaysia: Utility, Enablers, and Barriers.

Access to mental healthcare is undoubtedly of major importance for LGBT+ people worldwide, given the high prevalence of mental health difficulties due to minority stress exposures. This study drew mixed-method survey data from the community-based KAMI Survey (n = 696) to examine the enablers, barriers, and unmet needs experiences of LGBT+ individuals in accessing mental healthcare services in Malaysia. First, we present findings from a series of descriptive analyses for sociodemographic differences in unmet needs for mental healthcare, barriers, and satisfaction levels with different types of mental healthcare. Next, we conducted an inductive thematic analysis of open-text comments (n = 273), with relevance drawn to Andersen's Behavioural Model of Healthcare. More than a quarter (29.5%) reported an unmet need for mental healthcare, and some groups (younger, asexual or queer, or participants living in non-major cities) reported higher unmet needs. More than three-fifths (60.5%) reported not knowing where to find culturally safe mental health professionals. The thematic analysis uncovered key contextual (e.g., mental health practitioners' stance, stigma, collaborative client-care) and individual (e.g., positive expectation of mental health services and anticipated stigma) attributes that influence healthcare experiences. Participants also identified resources that facilitate healthcare utilisation, such as affordability, availability of suitable professionals, and geographical considerations. The implications of our findings for the mental healthcare practices in Malaysia were outlined.

Mental health prevalence, healthcare use and access between 2018 and 2022 in Sri Lanka: an analysis of survey data

Background Sri Lanka has suffered four decades of violent conflict, a tsunami, terrorist attacks and an economic crisis, with unknown mental health consequences. People living with mental health difficulties may experience individual, interpersonal, social or structural barriers to help-seeking. These may include stigma, lack of knowledge, denial, fear of societal repercussions, language, acceptability/appropriateness of care, lack of family support, availability of medication, lack of transport and financial barriers. It is possible that several of these factors may have manifested during the challenging time period for Sri Lankans at which this study took place. Methods Using a sample of 4030 respondents from two waves of a nationally representative survey, this study assessed the changes in the prevalence of mental health conditions, and subsequent changes in rates of healthcare usage and access, among adults in Sri Lanka between 2018 and 2022. This spanned a period of crisis and unrest, inclusive of the Easter Sunday attacks in 2019, anti-Muslim riots, the coronavirus disease 2019 pandemic and lockdown measures, as well as the current economic crisis that started in late 2021. Descriptive analyses were conducted to assess the demographic and socioeconomic characteristics of the cohort, and to quantify the prevalence of mental health difficulties within the cohort at each wave. Regression analyses examined the changes in prevalence of mental health difficulties over time. Cross-sectional descriptive analyses examined rates of healthcare use and access among those experiencing mental health difficulties, and regression analyses compared use and access for those experiencing different levels of mental health difficulties, adjusting for age, sex, education, socioeconomic status, ethnicity, religion, region and language. Results We found that 2.9% of Sri Lankans experienced high mental health difficulties during 2018–9 and 6.1% in 2021–2. There was a statistically significant increase in prevalence between 2018–9 and 2021–2 (β = 0.23, 95% confidence interval 0.20 to 0.26; p &lt; 0.05). This rise was disproportionately higher amongst older adults, those in the lowest socioeconomic classes, and those not from a minority ethnic group. The gap between inpatient use for those living with the highest and lowest levels of mental health difficulties widened across the study period, though the outpatient use gap remained stable. Finally, while those with high mental health difficulties reported high levels of unmet need for health care, when compared to those with the lowest levels of mental health difficulty, the difference was not found to be significant, likely due to a restricted sample size. Future work and limitations It would be beneficial for future studies to investigate issues with measuring mental health, applicability and the cultural safety of mental health measures. Conclusions We explored mental health in Sri Lankans during critical time periods when the country experienced various traumatic events. The lessons learnt from how mental health and healthcare access and use were measured in this study allows us to strengthen methods for future studies, allowing for robust longitudinal analyses of healthcare use and access for those experiencing common mental health difficulties. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 17/63/47. A plain language summary of this article is available on the NIHR Journals Library website https://doi.org/10.3310/HJWA5078.

Sociodemographic and Clinical Characteristics of People Living with Dementia and Their Associations with Unmet Healthcare Needs: Insights from the Baseline Assessment of the InDePendent Study.

The healthcare needs of People living with Dementia (PlwD) (such as Alzheimer's disease) are often unmet. Information about the needs of community-dwelling PlwD and their association with sociodemographic and clinical characteristics is needed to fill the knowledge gap regarding factors influencing unmet needs among PlwD and to conduct a comprehensive needs assessment to develop tailored interventions. To describe sociodemographic and clinical characteristics of the InDePendent study population with particular reference to determinants of unmet needs. We analyzed baseline data of the multi-centre cluster-randomized controlled trial (InDePendent) using descriptive statistics to describe patients' sociodemographic and clinical characteristics and Poisson regression models to predict unmet needs, separated by sex. Data were collected personally via face-to-face interviews. Most of the n = 417 participating PlwD were mild to moderately cognitively impaired, were not depressed, had an average of 10.8 diagnoses, took 6.7 medications, and had, on average, 2.4 unmet needs (62% of PlwD had at least one unmet need) measured by the Camberwell Assessment of Need for the Elderly (CANE). Low social support, a high body-mass-index, a lower education, functional impairment, and worse health status were associated with more unmet needs, regardless of sex. In women, higher unmet needs were associated with more depressive symptoms, a poor financial situation, living alone and not being recently treated by a general practitioner. In males, unmet needs increased with the number of medications taken. PlwD had a broad array of unmet healthcare needs, indicating primary healthcare provision improvement potentials. The results underscore the significance of early assessment of patient's clinical characteristics and unmet needs as a basis for individualized gender-sensible intervention strategies.∥ClinicalTrials.gov Identifier: NCT04741932, Registered on February 5, 2021.

Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study.

The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app's overall usability. We also calculated the participants' likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants' likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs' workloads. We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app's use and efficacy in real-world settings to support task-shared mental health programs across the United States.

Association between Adverse Childhood Experiences and Unmet Health Care Needs among Children in the United States

ABSTRACT Although studies have investigated and found an association between adverse childhood experiences and poor health and mental health outcomes, there is a dearth of studies investigating the association between adverse childhood experiences and unmet health care needs among children. The objective of this study is to examine the association between adverse childhood experiences and unmet health care needs after adjusting for predisposing, enabling, and need factors of health care service utilization. Data for this study came from the 2016–2017 National Survey of Children’s Health. An analytic sample of 46,081 children (51.3% males; average age 11.5 years) was analyzed using negative binomial regression. Based on parent reports, about 3.5% of children had unmet health care needs, and half (50%) of the sample had experienced at least one childhood adversity. Controlling for other factors, children who experienced three or more childhood adversities had 4.51 times higher odds of having unmet health care needs (AOR = 4.51, p < .001, 95% CI = 3.15–6.45) when compared to their counterparts with no childhood adversity. Children with parents who have someone to turn to for everyday emotional support were 31% less likely to have unmet health care needs (AOR = .69, p < .01, 95% CI = .54–.89). Adverse childhood experiences have a detrimental effect on unmet health care needs. The findings of this study offer an important opportunity for further research on how best to prevent adverse childhood experiences and mitigate their impact on families.