Urban Clients Research Articles

Affective Expertise

Alongside economic change, market socialism in Vietnam entails biopolitical campaigns to combat poverty as a “social problem.” Social workers in Hồ Chí Minh City function as agents of therapeutic governance to transform the lives of poor urban clients by employing empathetic interpersonal interaction grounded in scientific models of human behavior. Analysis of social workers’ affective expertise illuminates two gendered and classed consequences of their technoscientific interventions. First, social work is feminized, yet social workers often cannot achieve middle-class feminine ideals. Second, the casework approach risks naturalizing class inequality by atomizing structural problems as stemming from individual characteristics that require reform.

P082Rural-urban differences in post-abortion contraception use and past contraceptive access: A cohort study of abortion patients in utah

<h3>Objectives</h3> To evaluate the role of geography in post-abortion contraception choice and prior contraceptive barriers. <h3>Methods</h3> We recruited English- and Spanish-speaking abortion clients, aged 18–45, at a single facility in Salt Lake City, Utah. Participants enrolled between June 2021 and January 2022, and completed a baseline survey on the day of the abortion and a follow-up survey at three months. Rural-urban residence was determined using the Rural Urban Community Area (RUCA) classification system. We assessed demographic variables, method choice, and prior access barriers relative to geographic status. No-cost contraception was available for uninsured clients. <h3>Results</h3> We approached 779 clients and 527 (68%) completed the baseline survey (9.3% were rural). Rural clients were more likely to be multiparous and not in a committed relationship. Most participants (86.9%) planned to start a method after the abortion. Method choice was similar between groups, and long-acting reversible contraceptive (LARC) methods were most frequently selected (45.2% vs. 44.2%; p=0.62). Rural and urban clients reported similar rates of contraceptive access barriers in the past year (10.2% vs. 14.2%; p=0.52). Rural clients were more likely to report a >30-minute drive for contraception (15.4% vs. 9.2%; p=0.04), and higher rates of discomfort discussing contraception with local providers (30.4% vs. 10.9%; p=0.001). Regardless of residence, clients reporting prior difficulty accessing contraception (n=69) were more likely to select a LARC method (68.1% vs. 41.1%; p<0.01). <h3>Conclusions</h3> The contraceptive needs of rural and urban clients are similar; however, rural clients face unique barriers. The abortion visit is an important opportunity for care provision for clients with limited local access.

Returning to rural communities following transitional rehabilitation after spinal cord injury.

Spinal cord injury (SCI) is a lifelong condition requiring integrated hospital-based and community-based rehabilitation services to support the individual from acute injury to long-term community living. In Australia, transitional rehabilitation has been used to support the transition from hospital to home for people with SCI,1, 2 providing multidisciplinary rehabilitation using a client-centred and goal-directed approach. Inclusive of physiotherapy, occupational therapy, social work and nursing support, transitional rehabilitation is provided for 8–12 weeks following discharge from hospital using direct therapy, education and environmental modification. Located within a metropolitan city, urban clients are supported in their own homes, and rural clients in a homelike environment, using accommodation supplied by the service. However, previous research suggests that discharge planning remains complex, compromised by reduced client participation; difficulties in the identification, education, coordination and funding of local care providers; reduced family involvement; restricted contact with and access to social and community supports; limited specialist support; and challenges with skill acquisition and transfer of learning.3 Despite transitional rehabilitation approaching 20 years of service in Australia, the need remains to develop more effective models of rehabilitation for rural clients. The current study aimed to examine the challenges facing people with SCI returning to rural locations following transitional rehabilitation to inform service delivery.

P32 Evaluation of Multilevel Nutrition Interventions among Urban Clients on Charitable Food Assistance

<h3>Background</h3> Decreased accessibility to farmland and food insecurity in urban areas have expanded the need for emergency food assistance. The culture of food banks is evolving from a system that supplied non-perishable foods for immediate needs to more sustainable initiatives that emphasize access to healthier foods and nutrition education due to the rise of obesity and chronic diseases. Furthermore, minimal evaluation on produce consumption behaviors of underserved clients using resources from local and federal programs has been conducted. <h3>Objective</h3> Evaluate the relationship between usage of federal nutrition programs, local resources, and fresh produce consumption among clients on charitable food assistance. <h3>Study Design, Setting, Participants</h3> A cross-sectional design during Summer 2018 was implemented with 91 respondents (87% African American and 13% other) who met inclusion criteria for socioeconomic status at 5 faith-based and healthcare food pantries and clinics in Washington DC. Subjects completed informed consent, demographics, and the Eating at America's Table survey of fruit and vegetable consumption patterns. <h3>Measurable Outcome/Analysis</h3> R software version 3.5.3 was used for data analysis. Analysis of variance (ANOVA) Fisher Test measured the relationship between number of federal programs used and mean intakes of fresh produce as well as number of local nutrition resources used and mean intakes of fresh produce. ANOVA findings were confirmed via Tukey, Scheffe, and least square difference testing. <h3>Results</h3> Subjects who reported participation in 1 or more federal programs reported higher intakes of fruit, potatoes, non-starchy vegetables, and beans than those who did not (<i>P</i> < .05). Subjects who used 1 or more local nutritional resources reported higher intakes of fruit, potatoes, and non-starchy vegetables than those who did not (<i>P</i> < .05). <h3>Conclusions</h3> To improve food security and sustainability, urban communities, especially underserved areas, may benefit from multiple subsystems, including local food production and nutrition support from federal and decentralized community resources.

Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda

BackgroundAlthough Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)‘s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients’ and HIV service managers’ perspectives on barriers to implementation of Differentiated ART service delivery in Uganda.MethodsWe employed a qualitative descriptive design involving 124 participants. Between April and June 2019 we conducted 76 qualitative interviews with national-level HIV program managers (n = 18), District Health Team leaders (n = 24), representatives of PEPFAR implementing organizations (11), ART clinic in-charges (23) in six purposively selected Uganda districts with a high HIV burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held with patients enrolled in DSD models in case-study districts. Data were analyzed by thematic approach as guided by a multi-level analytical framework: Individual-level factors; Health-system factors; Community factors; and Context.ResultsOur data shows that multiple barriers have been encountered in DSD implementation. Individual-level: Individualized stigma and a fear of detachment from health facilities by stable patients enrolled in community-based models were reported as bottlenecks. Socio-economic status was reported to have an influence on patient selection of DSD models. Health-system: Insufficient training of health workers in DSD delivery and supply chain barriers to multi-month ART dispensing were identified as constraints. Patients perceived current selection of DSD models to be provider-intensive and not sufficiently patient-centred. Community: Community-level stigma and insufficient funding to providers to fully operationalize community drug pick-up points were identified as limitations. Context: Frequent changes in physical addresses among urban clients were reported to impede the running of patient groups of rotating ART refill pick-ups.ConclusionThis is one of the first multi-stakeholder evaluations of national DSD implementation in Uganda since initial roll-out in 2017. Multi-level interventions are needed to accelerate further DSD implementation in Uganda from demand-side (addressing HIV-related stigma, community engagement) and supply-side dimensions (strengthening ART supply chain capacities, increasing funding for community models and further DSD program design to improve patient-centeredness).

Coordinated Community-Based Hoarding Interventions: Evidence of Case Management Practices

Hoarding is a problem for which coordinated interprofessional interventions are suited to address associated health and safety concerns. Case management (CM) consists of a set of well-established strategies commonly used in community service settings to address serious mental illness and similar complex problems. The present study used qualitative methods to examine whether CM activities occurred in four North American community-based hoarding intervention models. Findings indicated interventions associated with hoarding cases mapped closely onto eight major functions of CM, though emphasis on specific CM activities depended on availability of resources. CM appears to be a useful rubric for approaching complex social and functional problems that arise among urban clients with hoarding disorder.

Preference and willingness to pay for nutritional counseling services in urban Hanoi.

Background: Despite substantial achievement in reducing malnutrition rates in Vietnam, there has been an increasing rate of overweight individuals in urban areas, which may result in a high burden of non-communicable diseases. Nutritional counseling clinics have been introduced in several settings; however, little is known about the preference for this service among urban clients. This study aimed to assess the preference and willingness to pay (WTP) for nutritional counseling services among urban clients. Methods: We interviewed 429 clients who attended Hanoi Medical University Nutritional Counseling Clinic (Hanoi, Vietnam). WTP was determined using double-bounded dichotomous-choice questions and open-ended questions. Results: In total, 78.6% respondents were willing to use nutritional counseling services. The mean amount of WTP for one-time service and one-year package was 96,100VND (~$4.3) and 946,400VND (~$41.9), respectively. Clients' willingness to use the service was higher among females, those seeking counseling for elderly people and those who preferred face-to-face counseling services (p<0.05). WTP was higher among those who were over 35 years old, those seeking services for the elderly people, those having poor nutritional status, and those having under-6 year old children (p<0.05). Conclusions: The preference and WTP for nutritional counseling services in urban Hanoi were relatively high. Scaling up this service is necessary to actively prevent and control the spread of non-communicable diseases.

Preference and willingness to pay for nutritional counseling services in urban Hanoi

Background: Despite substantial achievement in reducing malnutrition rates in Vietnam, there has been an increasing rate of overweight individuals in urban areas, which may result in a high burden of non-communicable diseases. Nutritional counseling clinics have been introduced in several settings; however, little is known about the preference for this service among urban clients. This study aimed to assess the preference and willingness to pay (WTP) for nutritional counseling services among urban clients. Methods: We interviewed 429 clients who attended Hanoi Medical University Nutritional Counseling Clinic (Hanoi, Vietnam). WTP was determined using double-bounded dichotomous-choice questions and open-ended questions. Results: In total, 78.6% respondents were willing to use nutritional counseling services. The mean amount of WTP for one-time service and one-year package was 96,100VND (~$4.3) and 946,400VND (~$41.9), respectively. Clients’ willingness to use the service was higher among females, those seeking counseling for elderly people and those who preferred face-to-face counseling services (p<0.05). WTP was higher among those who were over 35 years old, those seeking services for the elderly people, those having poor nutritional status, and those having under-6 year old children (p<0.05). Conclusions: The preference and WTP for nutritional counseling services in urban Hanoi were relatively high. Scaling up this service is necessary to actively prevent and control the spread of non-communicable diseases.

Preference and willingness to pay for nutritional counseling services in urban Hanoi

Background: Despite substantial achievement in reducing malnutrition rates in Vietnam, there has been an increasing rate of overweight individuals in urban areas, which may result in a high burden of non-communicable diseases. Nutritional counseling clinics have been introduced in several settings; however, little is known about the preference for this service among urban clients. This study aimed to assess the preference and willingness to pay (WTP) for nutritional counseling services among urban clients. Methods: We interviewed 429 clients who attended Hanoi Medical University Nutritional Counseling Clinic (Hanoi, Vietnam). WTP was determined using double-bounded dichotomous-choice questions and open-ended questions. Results: In total, 78.6% respondents were willing to use nutritional counseling services. The mean amount of WTP for one-time service and one-year package was 96,100VND (~$4.3) and 946,400VND (~$41.9), respectively. Clients' willingness to use the service was higher among females, those seeking counseling for elderly people and those who preferred face-to-face counseling services (p<0.05). WTP was higher among those who were over 35 years old, those seeking services for the elderly people, those having poor nutritional status, and those having under-6 year old children (p<0.05). Conclusions: The preference and WTP for nutritional counseling services in urban Hanoi were relatively high. Scaling up this service is necessary to actively prevent and control the spread of non-communicable diseases.

TACIT KNOWLEDGE TRANSFER: CROSS-CULTURAL ADVENTURE

We show here that adventure tourism leads to transfer of tacit knowledge between international visitors and local residents in developing destinations; and that motivations for the locals include money and employment, social capital, and individual enjoyment. Over the past half century, adventure tourism has grown from decentralised domestic outdoor recreation, to a large international commercial industry. Many tours bring urban clients from developed nations to rural areas in developing nations, where there are icon sites for specific adventure activities (Buckley, 2010).

American Indians with Substance Use Disorders: Treatment Needs and Comorbid Conditions

Background: American Indians and Alaska Natives (AI/ANs) experience significant disparities in health status and access to care. Furthermore, only limited data are available on substance use, mental health disorders, and treatment needs for this population. Addressing such disparities and developing culturally relevant, effective interventions for AI/AN communities require participatory research. Objectives and Methods: The Western States Node of the National Institute on Drug Abuse Clinical Trials Network partnered with two American Indian substance abuse treatment programs: an urban health center and a reservation-based program to assess client characteristics, drug use patterns, and treatment needs. Data collected by staff members at the respective programs from urban (n = 74) and reservation (n = 121) clients were compared. Additional sub-analysis examined patients reporting regular opioid use and mood disorders. Results: Findings indicate that urban clients were more likely to report employment problems, polysubstance use, and a history of abuse. Reservation-based clients reported having more severe medical problems and a greater prevalence of psychiatric problems. Clients who were regular opioid users were more likely to report having a chronic medical condition, suicidal thoughts, suicide attempts, polysubstance abuse, and IV drug use. Clients who reported a history of depression had twice as many lifetime hospitalizations and more than five times as many days with medical problems. Conclusions: Findings from this project provide information about the patterns of substance abuse and the importance of comprehensive assessments of trauma and comorbid conditions. Results point to the need for integrative coordinated care and auxiliary services for AI/AN clients seeking treatment for substance use disorders.

The Use of Telecommunication to Deliver Services to Rural and Urban Vocational Rehabilitation Clients

Telecommunication offers a cost-saving alternative to face-to-face vocational rehabilitation (VR) service delivery, yet little is known about the current use. This article describes findings from an exploratory survey of 1,187 counselors, representing 13 VR agencies across the United States. The online survey explored agency, counselor, and client facilitators and barriers to telecommunication use during the VR process. Staff with training in telecommunication strategies reported significantly higher rates of email telecommunication ( p &lt; .01). Counselors with a higher rural caseload mix engaged in significantly less email telecommunication during the VR process, and rural clients as compared with urban clients were characterized as having less personal access to a computer with Internet. Although counselors use and rely on simple telecommunication methods such as phone and email to serve their clients, strategies to address barriers are needed to expand telecommunication use during the VR process.

Comparing the effect of Amanah Ikhtiar Malaysia’s (AIM) microcredit program on quality of life in urban and rural Malaysia

This study was undertaken to measure and compare the impact of Amanah Ikhtiar Malaysia’s (AIM) microcredit programs on low-income household’s quality of life between urban and rural Peninsular Malaysia. To achieve the aforementioned objective, this study employed a cross-sectional data analysis using stratified random sampling method to examine whether participation in AIM’s microcredit programs improved the quality of life of low-income households. A quality of life index was developed using eleven selected indicators, namely, use of permanent housing materials for the walls, floors and roofs, environmentally safe cooking fuel, better access to public water supply and healthy sanitary facilities. Findings of this study revealed that with participation in AIM’s microcredit programs, the quality of life index as measured by these indicators improved for urban households. In fact, the overall quality of life among AIM borrowers was found to improve after participation. The current level of quality of life of the low-income urban households also appeared to be better than that of poor rural borrowers’ households. The results suggest that AIM should, therefore, focus on increasing the outreach by targeting ‘low income clients’ in urban as well as rural Malaysia. Moreover, AIM also should review and re-organize their programs in order to come up with a dynamic and well-diversified microfinance program to fulfill all financial needs of urban clients. Key words: Microcredit, poverty, quality of life, welfare, Malaysia.

Correlates of highly active antiretroviral therapy adherence among urban Ethiopian clients

There has been a massive expansion of highly active antiretroviral therapy (HAART) services in Ethiopia since 2005. To assess clients’ self-reported adherence to HAART medication, a descriptive, comparative cross-sectional study was carried out among adults receiving HAART medication at the Zewditu Memorial Hospital ART clinic in Addis Ababa. Of 1 808 clients eligible for the study, 1 722 agreed to participate. The data were collected over six weeks in February and March 2010. Ordered and binary logistic regression models were applied to analyse the data. The majority of participants were over age 30 years, most were females, and 90% had some formal education. More than half reported being ‘extremely sure’ about their ability to take most or all of their medication. Self-reported adherence to the medication was generally good, as 62% said they had never missed a dose. The most commonly cited reason for missing medication was being busy (57.5%). The odds of ever missing a dose of HAART were lower for males (adjusted odds ratio [AOR]: 1.44; 95% confidence interval [CI]: 1.15–1.79), older persons (AOR: 0.98; 95% CI: 0.97–0.99), and those who did not drink alcohol regularly. Similarly, the odds of being self-confident about taking the medication properly were higher for males and for those who did not drink alcohol regularly (AOR: 0.48; 95% CI: 0.35–0.64). The odds of self-confidence in taking the medication were lower among those in lower income group. Those who reported an expenditure income of Birr 501–999 (AOR: 0.35; 95% CI: 0.24–0.49) or Birr 1 000–1 999 (AOR: 0.41; 95% CI: 0.29–0.60) had less self-confidence in taking their medication properly as compared to those who had an expenditure income of Birr 2 000 or more. There is a need to design and implement targeted adherence interventions that could lead to better treatment outcomes.

Urban–Rural Differences in Internet Usage, e‐Commerce, and e‐Banking: Evidence from Italy

ABSTRACT By reducing the cost of performing isolated economic activities in remote areas, information technology might serve as a substitute for urban agglomeration. The paper assesses this hypothesis using data on Italian households' usage of the Internet, e‐commerce, and e‐banking. The results do not support the argument that the Internet reduces the role of distance. Internet usage is much more frequent among urban consumers than among their non‐urban counterparts. The use of e‐commerce is basically unaffected by the size of the city where the household lives. Geographically remote consumers are discouraged from purchasing goods by the fact that they cannot inspect them beforehand. Leisure activities and cultural items (i.e., books, CDs, and tickets for museums and theaters) are the only goods and services for which e‐commerce is used more in isolated areas. Finally, e‐banking bears no relationship to city size. In choosing a bank, non‐urban customers give more importance to personal acquaintance than do urban clients, partly because bank account holders in remote areas are more likely to have taken out a loan from their bank.

Rural and agricultural finance: emerging practices from Peruvian financial institutions

The formal financial system in Peru provides very limited rural and agricultural finance services and most financial institutions focus uniquely on serving urban clients. If financial institutions lend to agriculture at all, it is primarily to large agro-processors or input suppliers, rather than to farmers directly. Even microfinance providers, which are more inclined to serve the needs of the rural poor, focus on the urban areas of Peru. Given the Peruvian microfinance industry's 20 per cent growth last year, microfinance providers are likely to continue to focus on unserved urban markets, which are easier to serve than rural markets. However, several financial institutions in Peru are making efforts to serve poor clients with a variety of rural and agricultural finance product and process innovations that reduce transaction costs and manage risks. This article captures some of the emerging products and processes of four Peruvian financial institutions, which may have applicability to other countries as...

Reducing borrower and lender risk in Tajikistan through context-sensitive product and portfolio design

How can MFIs be helped to move from mainly urban clients to smallholder farmers? This case study shows how sustainable financial services for rural households have been developed in Tajikistan. Since 2004, MEDA has been implementing a four-year $4.5 million CIDAfunded agricultural development programme that focuses on the horticulture subsector. A key component of the project is to partner with and develop the capacity of a local MFI (microfinance institution); and a $1 million agricultural loan fund has been made available for this purpose, along with technical assistance and temporary operational support. The primary technical challenges have been to assess the local context accurately and, based on the findings, assist the MFI to design appropriate products and develop a balanced portfolio to meet the needs of the borrower and lender, reducing the risk to both. Special attention has been paid to borrowers' sources of income and agricultural cycles. The disbursement and repayment of the $1m loan portfolio has been so successful that the MFI was able to cover operating costs of the portfolio from interest earned within 18 months and reported almost no default. Farmers continue to take loans, raise their incomes and seek out additional loan products. The context-sensitive design of products and the portfolio has enabled the MFI to expand successfully into rural lending. Building on this success, the MFI now manages microfinance funds of over $7 million and has become the leader in rural finance in Tajikistan over the past three years.

Rural and agricultural finance: emerging practices from Peruvian financial institutions

The formal financial system in Peru provides very limited rural and agricultural finance services and most financial institutions focus uniquely on serving urban clients. If financial institutions lend to agriculture at all, it is primarily to large agro-processors or input suppliers, rather than to farmers directly. Even microfinance providers, which are more inclined to serve the needs of the rural poor, focus on the urban areas of Peru. Given the Peruvian microfinance industry's 20 per cent growth last year, microfinance providers are likely to continue to focus on unserved urban markets, which are easier to serve than rural markets. However, several financial institutions in Peru are making efforts to serve poor clients with a variety of rural and agricultural finance product and process innovations that reduce transaction costs and manage risks. This article captures some of the emerging products and processes of four Peruvian financial institutions, which may have applicability to other countries as well.

Reducing borrower and lender risk in Tajikistan through context-sensitive product and portfolio design

How can MFIs be helped to move from mainly urban clients to smallholder farmers? This case study shows how sustainable financial services for rural households have been developed in Tajikistan. Since 2004, MEDA has been implementing a four-year $4.5 million CIDAfunded agricultural development programme that focuses on the horticulture subsector. A key component of the project is to partner with and develop the capacity of a local MFI (microfinance institution); and a $1 million agricultural loan fund has been made available for this purpose, along with technical assistance and temporary operational support. The primary technical challenges have been to assess the local context accurately and, based on the findings, assist the MFI to design appropriate products and develop a balanced portfolio to meet the needs of the borrower and lender, reducing the risk to both. Special attention has been paid to borrowers' sources of income and agricultural cycles. The disbursement and repayment of the $1m loan portfolio has been so successful that the MFI was able to cover operating costs of the portfolio from interest earned within 18 months and reported almost no default. Farmers continue to take loans, raise their incomes and seek out additional loan products. The context-sensitive design of products and the portfolio has enabled the MFI to expand successfully into rural lending. Building on this success, the MFI now manages microfinance funds of over $7 million and has become the leader in rural finance in Tajikistan over the past three years.

Rural versus Urban Clinical Needs

The purpose of this study was to explore treatment issues in both urban and rural family therapy centers to see if differences exist. By examining approximately five years of data from two different MFT centers, one rural (n = 252) and the other urban (n = 558), we explored if there were differences in clients' presenting problems (n = 810). Findings suggest that while there are similarities in presenting problems, the differences among leading presenting problems of rural versus urban clients were statistically significant. The leading reason for treatment among rural clients was enrichment, whereas for urban clients it was parenting/child problems. In addition, there were also differences in presenting problems depending on whether the clients were individuals, couples, or families. Implications for treatment, future research, and international applications will be presented.