Use Of Preventive Health Care Services Research Articles

The role of sociodemographic, psychosocial, and behavioral factors in the use of preventive healthcare services in children and adolescents: results of the KiGGS Wave 2 study

BackgroundIn Germany, various preventive services are offered to children and adolescents. These include regular standardized examinations (so called U/J examinations) and several vaccinations. Although strongly recommended, most of them are not mandatory. Our aim is to identify factors associated with the use of U/J examinations and vaccination against diphtheria, hepatitis B, Hib, pertussis, polio, and tetanus. While previous research has focused on sociodemographic factors, we also include socioeconomic, behavioral, and psychosocial factors.MethodsWe analyzed cross-sectional data from 15,023 participants (aged 0–17 years) of the nationwide representative KiGGS Wave 2 Survey. Participation in U/J examinations was assessed using a questionnaire, filled out by participants and/or their parents. Information on vaccination status was drawn from the participants’ vaccination booklets. To identify relevant determinants for the use of preventive examinations and vaccinations, unadjusted and adjusted logistic regression models were employed with up to 16 different independent variables.ResultsVarious independent variables showed an association with the use of preventive services. Higher socioeconomic status, absence of migration background, and lower household size were associated with significantly higher utilization of U examinations. Parents’ marital status, area of residence, behavioral and psychosocial factors yielded insignificant results for most U/J examinations. Higher vaccination rates were found for children with no migration background, with residence in eastern Germany, lower household size, and with married parents.ConclusionThis study attempted to depict the influence of sociodemographic, psychosocial, and behavioral factors on the use of several preventive services. Our results indicate that predominantly sociodemographic variables influence the use of preventive services. Further efforts should be made to investigate the interplay of different determinants of healthcare use in children and adolescents.

Medical Care Needs of Laundromat Users in San Antonio, Texas: A Potentially Unique Setting for Health Interventions.

Innovative community-based public-private partnerships are forming to address health needs of underserved communities. This study partnered with laundromats in San Antonio, Texas to understand the health and healthcare needs of laundromat users as a possible underserved population. A total of 193 laundromat users across eight laundromats participated in a survey based on the Texas Behavioral Risk Factor Surveillance System (BRFSS) that asked about health status, access to care, vaccinations, and use of preventive healthcare services. Responses were compared to population estimates from Bexar County and the state of Texas. Results showed that over half of the sample of laundromat users were female, racial/ethnic minorities, living at poverty level, and did not have health insurance coverage. Compared to county and state population estimates, laundromat users were significantly more likely to report poor health and physical impairment; and were less likely to have a primary care provider, to have received a routine medical checkup in the past year, and to have been tested for HIV. Laundromat users were also less likely to receive some gender-specific preventive healthcare screenings such as pap smears and mammograms for women, and prostate exams for men than county or state population estimates. In the laundromat sample, 78% expressed interest in receiving healthcare services on-site at laundromats. Together, these findings suggest laundromats may be a unique setting for healthcare intervention to reach undeserved, racial/ethnic minority communities. Pilot programs that target this setting are needed to explore this opportunity to deliver community-based public health practice.

Neighborhood Disorder, Social Ties, and Preventive Healthcare Utilization among Urban-Dwelling Older Adults.

Objectives: This research examines whether perceived neighborhood disorder influences the use of preventive healthcare services (i.e. influenza vaccine, pneumonia vaccine, cholesterol screening, colonoscopy, and dental care) by older adults and whether social ties buffer the potential adverse effects of perceived neighborhood disorder. Methods: Using data from the 2012 wave of the Health and Retirement Study, binary logistic regression was used to generate odds ratio estimates of preventive healthcare use in the past 2years. Results: We find that greater levels of neighborhood disorder were associated with fewer dental care visits net of social and health factors. Regular participation in four or more social activities was associated with decreased odds of restricted use and increased odds of receiving a pneumonia vaccine and colonoscopy. Discussion: This research provides evidence that perceived neighborhood disorder may act as a barrier for specific preventive healthcare services and highlights the need for targeted intervention.

Relationship of health literacy with utilization of health-care services in a general Japanese population.

Many studies have explored the association between health literacy and health-care utilization; however, the majority assessed functional health literacy in terms of basic skills. Japan's health-care and medical examination system in workplaces is different from that of other major countries. This study examined the relationship of health literacy with health-care use (emergency visit, hospitalization, dental checkup, and health checkup or cancer screening); it focused on differences by occupation and health-care service utilization among general Japanese using the communicative and critical health literacy scale. We conducted a cross-sectional observational study of 1002 Japanese residents. Through a questionnaire, we investigated socioeconomic status, health status, health-care use, and health literacy. Among all participants and non-workers, logistic regression analyses revealed that health literacy was significantly associated with health checkup or cancer screening after adjusting for sex, age, marital status, education, and having a disease or disorder (adjusted odds ratio [OR] = 1.431, 95% confidence interval [CI], 1.131–1.810; adjusted OR = 1.614, 95% CI, 1.114–2.339, respectively). Among workers, we observed no significant association between health literacy and health-care utilization. These results indicate that health literacy is closely related to use of preventive health-care. Japan's health-care system in workplaces may promote use of preventive health-care services regardless of health literacy, whereas improving health literacy may be more critical among non-workers.

Personality and preventive healthcare utilisation: Evidence from the Irish Longitudinal Study on Ageing

There is extensive empirical evidence that personality is associated with many outcomes and behaviours, such as educational outcomes, labour market participation, savings behaviour, health behaviours, physical health status and mortality. Use of preventive healthcare services (e.g., vaccinations, screening, etc.) is a potential pathway explaining the link between personality and health, and is an important component of healthy ageing. We examine the association between personality traits (the ‘Big Five’) and a variety of preventive healthcare utilisation measures in the older population. Using data from the Irish Longitudinal Study on Ageing (TILDA), we estimate Poisson models of preventive healthcare utilisation (influenza vaccination, blood cholesterol test, breast lump check, mammogram, prostate examination, prostate-specific antigen (PSA) test). We find that openness to experience is a significant predictor of breast lump check and mammogram in women aged 65+ after adjustment for other confounders and multiple hypothesis testing. While uptake of many preventive healthcare services remains below national recommendations for the older population, with the exception of breast lump checks and mammograms for women aged 65+, we find little evidence to link this heterogeneity in uptake to personality.

Accesibilidad y utilización de servicios de salud en hombres con discapacidad motora.

Objetivo: Determinar los factores asociados a la accesibilidad y utilización de servicios de salud preventivos en hombres con discapacidad motora de una localidad de la ciudad de Cartagena. Materiales y métodos: Estudio analítico de corte transversal, población de referencia de 1.661 adultos con discapacidad motora. La muestra fue de 204 hombres con discapacidad motora. Muestreo aleatorio estratificado. Para la recolección de la información se aplicó un instrumento que incluyó una ficha sociodemográfica, ficha de uso, diseñada por los autores, cuestionario APGAR familiar (fiabilidad de 0.79), cuestionario de apoyo social Duck 11 (alfa de Cronbach de 0,90) además la escala para medir la satisfacción (fiabilidad de 0.82). La información obtenida se procesó en Microsoft Excel y fue analizada en el programa estadístico SPSSS versión 20. Resultados: Edad promedio 45 años (DE= 12,9 años), el 72,5% (148) proceden del área urbana, 44,5% (90) tiene pareja, 59%(122) ha tenido una consulta en los últimos 6 meses y solo 6,5%(8) asiste por estar inscrito a programas de promoción y prevención. El 52,5% (107) considera que el centro de salud queda lejos de su vivienda, 53% (108) espera para ser atendido desde de 30 a 60 minutos, 55,4% (113) espera más de 7 días para asignación de citas médicas. Conclusiones: El uso de servicios de salud preventivos está mediado por determinantes personales como tener una pareja y estudios superiores a la secundaria; así mismo, el apoyo social, la satisfacción con el acceso y la infraestructura de los centros de salud facilitan la utilización de estos servicios.

Preventive healthcare services use among transgender young adults

ABSTRACTBackground/Aims: Existing research on the health of transgender young adults focuses largely on gender-related care with little attention to important preventive healthcare services such as well-visits, vaccination and screening.Methods: We analyzed data from a national sample of transgender young adults in the United States who were 18–26 years of age and completed an online survey during Fall 2013 (n = 34). Most respondents were 22–26 years old (59%) and non-Hispanic White (68%). We calculated descriptive statistics (i.e., frequencies and percentages) to describe transgender young adults use of preventive healthcare services, with particular attention to vaccination against human papillomavirus (HPV) and sexual health services. We also examined the acceptability of home-based self-testing for sexually transmitted infections (STIs), which could be a novel strategy for increasing screening among this population.Results: Only 35% of respondents reported either receiving a routine check-up (past year) or initiating the HPV vaccination series (≥ 1 dose). Among unvaccinated respondents, the most commonly reported reasons for not getting HPV vaccine were: not being sexually active (32%); having only one sexual partner (23%); and being unaware of the vaccine (23%). Fewer than half of respondents had been tested for STIs (47%) but most (71%) were willing to use an STI self-test at home.Discussion: Findings suggest that the healthcare needs of transgender young adults are not being adequately addressed. Efforts to increase providers' capacity to effectively and appropriately serve transgender young adults—such as a wider variety of exam, preventive services, and testing options (e.g., self-collected samples)—are needed.

Perceived Neighborhood Social Cohesion and Preventive Healthcare Use

Neighborhood social cohesion has been linked with better health and health behaviors, but its association with patterns of preventive healthcare use remains understudied. The hypothesis was that people with higher perceived neighborhood social cohesion would display increased use of preventive healthcare services. Participants (N=7,168) were drawn from the 2006 wave of the Health and Retirement Study-a prospective and nationally representative panel study of American adults aged >50 years-and tracked for one wave (2 years). Analyses were conducted in 2016. After adjusting for sociodemographic factors and baseline health, each SD increase in neighborhood social cohesion was associated with a higher likelihood that people would obtain influenza vaccinations (OR=1.09, 95% CI=1.04, 1.15) or cholesterol tests (OR=1.10, 95% CI=1.02, 1.19). Further, women were more likely to receive mammograms/x-rays (OR=1.10, 95% CI=1.01, 1.19) or Pap tests (OR=1.08, 95% CI=1.00, 1.17). However, men were not more likely to receive prostate exams (OR=1.06, 95% CI=0.96, 1.17). With additional research, findings from this study may inform the development of new strategies that increase the use of preventive healthcare services and enhance the quality of life among people moving through the ranks of this aging society.

Does China's new cooperative medical scheme promote rural elders' access to healthcare services in relation to chronic conditions?

This study examined use of healthcare services by elderly people with a long-term condition living in rural China and participating in that country's New Cooperative Medical Scheme (NCMS). Data were taken from the 2009 China Health and Nutrition Survey. The study results showed that education level and annual income were low among rural elders (aged ≥65 years); the illiteracy rate was 58.0% (200/345) and 67.6% (92/136) had an annual income of less than 5000 Chinese yuan renminbi. The elders had low rates of treatment and use of preventive healthcare services while the prevalence of chronic disease was highest among them when compared to other age groups. Among the few elders who received preventive healthcare, most received it at village clinics. Preventive healthcare services and chronic disease management are urgently needed by rural elders in China. NCMS should initiate payments to township health centers to enable them to undertake community outreach and education campaigns among rural residents, and train village doctors in standard chronic condition management and prevention, with prioritization of the provision of prevention and management of chronic conditions by village clinics.

Health Behaviors of People with Retinitis Pigmentosa in the Republic of Korea

Purpose: To investigate the health behaviors of people with retinitis pigmentosa (RP) in the Republic of Korea.Methods: An online questionnaire was used to survey members of the Korean Retinitis Pigmentosa Society (KRPS), over 3 months from December 2010 to February 2011. Controls were selected from participants of the 4th Korean National Health and Nutrition Examination Survey and were matched with people with RP using the propensity score method to optimize comparative analysis. A semi-structured interview was also conducted with five members of the KRPS to identify potential reasons for physical inactivity and unhealthy diet and to develop effective interventions.Results: A total of 194 eligible people with RP responded to the online survey, and 187 individuals were matched with the control population by propensity score matching. RP subjects reported a lower rate of current smoking and greater use of preventive healthcare services. However, people with RP were more physically inactive (50.8% vs 27.3%, p < 0.001) and consumed more fast food (69.5% vs 58.3%, p = 0.024) than the control population.Conclusion: Physical inactivity and fast food consumption were more frequently reported in people with RP than the general population. Efforts to understand the possible reasons and develop interventions to improve these health behaviors are warranted.

Sociodemographic Determinants in Preventive Tests for Cardiovascular Diseases in a Representative Sample of the Adult Greek Population

The purpose of the current study is to investigate the use of preventive healthcare services by the adult Greek population and the factors that determine such use. Data were obtained from a national household survey (Hellas Health I) conducted during 2006. The survey population consisted of 1,005 individuals, with a mean age of 47.4 years. Candidate respondents were selected by means of a three-stage, proportional to size, sampling design. Chi-square tests and logistic regression analyses were used (p < 0.05). Among the determinants of performance of screening tests, gender, age, marital status, the presence of chronic illness and self-reported health status and the use of a family doctor play an important role. According to the findings of our study, screening tests are performed in a low percentage of the Greek population, even for individuals at increased risk for cardiovascular disease. It is obvious that doctors should focus more on such population groups, while national health policies promoting screening tests and prevention in general are warranted.

Determining factors for utilization of preventive health services among adults with disabilities in Taiwan

Taiwan has provided free health checks for adults since 1995. However, very little previous research has explored the use of preventive health services by physically and mentally disabled adults. The present study aimed to understand this use of preventive health services and the factors that influence it. Research participants included disabled people registered in a Ministry of the Interior database in 2008 (a total of 785,746 adults who met the conditions for being physically or mentally disabled and using preventive health services). These data were merged with the Bureau of Health Promotion's 2006-2008 dataset on preventive health and the 2006-2008 health insurance database published by the National Health Research Institutes. In addition to descriptive and bivariate analysis, the study used logistic regression analysis to investigate the factors that influence the use of adult preventive health services. The results showed that 15.81% of physically and mentally disabled adults used preventive health services. The rate of use among females was significantly higher than the rate among males, and rates were higher among residents of relatively less urbanized areas. Usage rates were also universally higher among sufferers of chronic diseases. However, more serious disabilities had lower usage rates. From the logistic regression analysis, we ascertained that the factors that influenced the use of preventive health services were gender, age, level of urbanization, monthly salary, low-income household status, aboriginal status, catastrophic disease/injury status, chronic diseases, type of disability, and severity of the disability. The study's main conclusion is that although Taiwan's Department of Health has provided free preventive health services for more than 15 years, the usage rate of this care among the disabled remains low. Demographic features, health status, and type of disability are the main factors influencing the use of preventive healthcare services.

Health insurance coverage and the use of preventive services by Mexican adults

The lack of health insurance coverage could be a potentially important deterrent to the use of preventive health care by older adults with high rates of chronic co-morbidities. We use survey data from 12 100 Mexican adults ages 50 and older who participated in the 2001 Mexican Health and Aging Study (MHAS) to analyze the relation between health insurance coverage and the use of preventive health-care services in Mexico. Uninsured adults were less likely to use preventive screenings for hypertension, high cholesterol, diabetes and (breast, cervical and prostate) cancer than insured adults. After adjusting for other factors affecting preventive care utilization in a logistic regression model, we found that these results still hold for high cholesterol and diabetes screening. Similar results hold for the population not working during the survey week and for adults earning below 200% of the poverty line. Our results suggest that insured adults are in a relatively better position to detect some chronic diseases - and have them treated promptly - than uninsured adults because they have better access to cost-effective preventive screenings. Recent public policy initiatives to increase health insurance coverage rates in Mexico could lead to substantially higher preventive health-care utilization rates and improvements in population health.

Health promotion and cancer screening services for African refugee women

6101 Background: Previous work has shown that refugee women do not receive adequate preventive healthcare services, especially cancer screening. To identify factors that could affect the provision of cancer screening services to African Somali refugee women living in Rochester, NY, we assessed beliefs these women have about health promotion, access to care and use of preventive healthcare services. Methods: Individual in-depth interviews were conducted on a community-based sample of 34 resettled Somali-born women who were older than 18 years. Interviews were audiotaped and transcribed verbatim. A professional interpreter listened to all audiotaped interviews to check accuracy of transcription and translation. Content was analyzed by a multidisciplinary team using a grounded theory approach. Results: Median age of the women was 27 years. Length of residence in US was two months to nine years. For these women, health maintenance for acute survival took precedence over long-term prevention of disease. All women were familiar with basic health promotion practices, immunizations and routine medical examinations, and participants used both US-based and traditional techniques to prevent illness. Most women (71%, n=24), recognized the importance of maintaining good hygiene (59%, n=20) understood the need to have an adequate source of safe food and water, (74%, n=25) saw the need for access to a regular source of healthcare and (65%, n=22) acknowledged the need to function well at home. Few women understood cancer prevention services. Only three (9%) women recognized that the purpose of the Papanicalaou test was to screen for cervical cancer. Only six women (18%) recognized mammography (either the term or the procedure) and all of them were English-speaking, had lived in the US five years or longer, and had worked in the healthcare field. Conclusions: While traditional beliefs about health promotion did not appear to impede delivery of most preventive services, and participants understood prevention of infectious disease, their familiarity with cancer and cancer screening services was poor. Future health promotion programs need to increase refugee women’s knowledge about these services while building on other positive health-promoting beliefs. Supported by AHRQ 5R03HS014105 and NCI 1R25CA102618 No significant financial relationships to disclose.

Colon Cancer Screening in 2005: Status and Challenges

The field of colon cancer screening has evolved dramatically in the last 15 years regarding evidence, guidelines, and practice. In 1990, no evidence from a randomized controlled clinical trial (RCT) existed to show that colorectal cancer (CRC) screening was effective in reducing CRC mortality. In 1990, although some guidelines endorsed screening, there was disagreement among recommending organizations about which tests to recommend or whether to recommend any screening tests at all. The US Preventive Services Task Force (USPSTF), arguably the most influential of the recommending organizations and the most rigorously evidence based, said that evidence was insufficient to recommend either for or against CRC screening.1 In this environment, CRC screening was not widely practiced, much less reimbursed by payers. If screening was performed at all, fecal occult blood testing (FOBT) was the most common test. Sigmoidoscopy was performed less frequently, and colonoscopy, rarely performed for screening, was used mainly for workup of a positive FOBT or sigmoidoscopy and for postpolypectomy surveillance. The primary questions facing academics, recommending organizations, and practicing clinicians in 1990 were (1) does CRC screening—of any kind—work to reduce CRC mortality, and (2) should it be implemented and reimbursed? In 2005, the situation is dramatically different. We now know that CRC screening works, and it is now being implemented and reimbursed. Colonoscopy has become popular as a primary screening test, and new tests, such as virtual colonoscopy, are being developed. The purpose of this article is to identify current challenges in light of the evolution of evidence, guidelines, and practice and to anticipate the next phase of development and implementation.

The use of preventive healthcare by Canadian women who drink alcohol

Background Despite established links among heavy alcohol consumption, other poor health behaviors, and poor health status, no Canadian study has specifically addressed the relationship between drinking and the use of preventive healthcare services. This study examines the relationship between drinking and female-specific preventive health service use through a secondary analysis of the 1996–1997 NPHS. Methods Recent use of Pap smears and mammograms was examined in relation to current alcohol consumption, using multivariate logistic regression (weighted n = 25,095). Results In general, there was a trend toward greater odds of recent service use among light and moderate drinkers than among heavy drinkers and lifetime abstainers. However, only moderate drinkers were significantly ( P < 0.01) more likely than abstainers to have recently had a Pap smear. Conclusions The trend toward lower use of preventive services by heavy drinkers is concerning considering the established harmful effects of prolonged alcohol consumption on health and the tendency for multiple risk behaviors to cluster together in the same individuals. Early detection of departures from good health may alleviate the elevated use of healthcare services among those diagnosed with alcohol use disorders.

Comparison of utilization of preventive health care services between two racial populations

PURPOSE: The difference in utilization of existing preventive health care services (PHCS) may be related to race. We compared the difference in use of PHCS between black and white males in Northwest Louisiana.METHODS: A cross-sectional survey regarding utilization of preventive health care services was conducted from 09/93–10/97. Approximate equal number of white and black males participated in this quota survey.RESULTS: 70% of black males said they had ever gone to the doctor for routine preventive check-up, while 79% of white males did so (p < 0.001). For those who previously had a routine preventive check-up, 88% had their last one within one year. Most routine check-ups are provided as part of the employment. The white males are 1.4 times more likely to have a routine check-up as compared to black males (p < 0.05). Factors which have a positive effect on use of PHCS are education (OR = 1.07, p < 0.01); intent to get a check-up (OR = 9.0, p < 0.001); the doctor spending enough time with the patients (OR = 2.4, p = 0.01); and wanting some health information (OR = 1.7, p < 0.001). Factors which have a negative effect on use of PHCS are cost (OR = 0.73, p = 0.046); having to go to different places (OR = 0.65, p = 0.024); and being scared of the doctor (OR = 0.46, p < 0.001). An indication of a negative effect-although not statistically significant-was found for long waiting time (OR= 0.73, p = 0.55) and the doctor not spending enough time explaining to patients (OR = 0.47, p = 0.054).CONCLUSIONS: White males that are more likely to use PHCS as compared to African-Americans. People of higher education with a positive intent and actively seeking health information are more likely to use PHCS. The more time the doctor spends with the participant, the more likely it is the participant will come for a routine check-up. The barriers for use of PHCS are cost, having to go to different places, and being scared of the doctor.