Health Care Users Research Articles

Reported side effects from hormonal contraceptives among those seeking abortion care versus contraceptive services.

We aim to describe and compare the prevalence of subjective side effects associated with hormonal contraceptive use among reproductive healthcare users seeking either abortion care or contraceptive services. This substudy derives from a previously reported cross-sectional survey involving 1006 users of public reproductive healthcare services in the Helsinki metropolitan area in Finland. We included all 813 respondents with a history of hormonal contraceptive use (mean age 27 years, IQR 24-33 for abortion care; 24 years, IQR 19-30 for contraceptive services). The study followed STROBE guidelines. Altogether 400 respondents sought abortion care, while 413 sought contraceptive services (counselling, prescription renewal, symptoms and/or dissatisfaction with their contraceptive method). Combined oral contraceptives and progestin-only pills were the most used methods in both groups. Respondents seeking abortion care reported contraception-associated weight changes, sex-related problems, mood changes, and acne more frequently than those seeking contraceptive services (p-value<0.05 for all). Some 52% of respondents seeking abortion care reported mood changes compared with 29% of those seeking contraceptive services, with a crude OR of 2.7 (95% CI 2.00 to 3.57). After adjustment, the OR for reporting mood changes among respondents seeking abortion care was 1.5 (95% CI 1.05 to 2.23). Mood changes associated with hormonal contraceptive use were the most frequently reported side effect among all respondents. These findings suggest a need for individualised counselling on mood-related side effects as mood changes may contribute to higher discontinuation rates.

Accessibility of digital healthcare in 2023: insights from a Dutch national survey study

Abstract Background Digital technology is reshaping healthcare, offering potential improvements in accessibility, efficiency and quality. However, to realize potential benefits, ensuring equal access for all is crucial. We investigated digital healthcare usage and studied differences in use across age groups and educational backgrounds in the Netherlands. Methods Surveys were conducted among general healthcare users (n = 837, any citizen living in the Netherlands with access to healthcare) and healthcare users with chronic conditions (n = 1437). We studied their digital skills (can you independently use a computer, tablet or smartphone; digital applications; email and apps?) and their use of digital selfcare (did you use websites for health-related information or treatment?). Findings are stratified for educational level (low/medium/high) and age (15 -39, 40-64, over 65 years). Data collection occurred between April and August 2023, focusing on the twelve months preceding the survey. Results The majority of respondents use digital devices independently (range: 78-91%), but these percentages vary between subgroups, from 48-65% for users with lower education vs 86-99% for users with higher education. Similar differences exist across age groups: 98-100% of users aged 15-39 use a computer, tablet or smartphone, in contrast with 59-78% in the over 65 years age group. Similarly, the use of websites for health information is 22-31% among lower educated users to 68-70% among higher educated users; and 36-48% among those ≥65 years to 73-75% among respondents aged 15-39. Conclusions Substantial variation exists in the use of digital tools and digital selfcare across ages and educational levels. These findings underscore the urgency of addressing inequalities in access to digital healthcare, serving as a call to action for policymakers, healthcare providers, and developers to collectively strive for an accessible (digital) healthcare system for all. Key messages • Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation. • Differences in use of digital tools and digital selfcare among people of different ages and educational levels warrants the need for co-creation and tailored development and implementation.

Racism in inpatient settings in Germany: professionals’ perspectives

Abstract Background Experiences of racial discrimination during healthcare encounters have increasingly been recognised as a source of health inequity. Narrative accounts by racialised healthcare users have dominated research in the field but it is equally important to capture the perceptions and practices of professionals to understand how racism operates in healthcare provisioning. This presentation asks: how does racism manifest in the German inpatient healthcare system (hospitals, rehabilitation facilities), and are there areas or phases of healthcare provisioning where racism is observed more frequently? Methods Problem-centred expert interviews (Döringer 2021) with 20 healthcare professionals from medicine, nursing, and therapeutic professions working in hospitals or rehabilitation facilities across three German federal states. Data were analysed using documentary method (Bohnsack 2002). Results Racism occurs widely in German inpatient settings. It manifests both structurally, e.g. in the absence of professional translators for healthcare users with limited German skills, and interpersonally, e.g. in the form of microaggressions and stereotyping but also the witholding of treatment and verbal abuse. Targets of racism are both patients and staff, especially internationally recruited healthcare workers. Respondents thereby identify night shifts, psychiatric settings and the emergency ward as contexts where racism is more likely to occur. The hierarchical nature of and pervasive power asymmetries in hospitals thereby prevent effective interventions against racial discrimination. Conclusions Racism in German healthcare institutions requires multiscalar public health interventions, particularly at the level of the institutions themselves. These include the establishment of a robust and low-threshold complaints structure, spaces for self-reflection for professionals, and mandatory anti-racism training rather than a focus on diversity-sensitive competence. Key messages • In future research approaches, structurally determined reproductions of racism should be investigated using a multi-method approach. • Experiences of powerlessness are reported by both those affected by racism and those professionals who observe racism and should be addressed by the institutions.

Dis-continuity in Continuity-of-Care: a pathway for more equal access to mental health care services?

Abstract Background Access to healthcare is core to achieving universal health coverage. Reaching and obtaining appropriate health care services requires engagement by health care organizations and users. For people with mental illness, access emerges as a continuous process, reflecting oscillating health conditions. This challenges aspirations of continuity of care (COC), but we know little about the experiences of users. Methods We carried out observations of interactions between professionals and users (n = 18) and semi-structured interviews with users, professionals, and managers (n = 33) in the specialised mental health services in Central Denmark Region and FACT-inspired teams in three municipalities. We also conducted 3 focus groups with regional and municipal professionals from these teams. Data was analysed through a qualitative thematic analysis. Results From the perspective of users, COC builds on the acknowledgment of their entire life situation. For users, this is about making connections between their past, present and future lives. Past experience affect their present abilities to follow treatment and influence future hopes and expectations. The acknowledgment of these connections often translates into spaces of discontinuity in continuity, where users need occasional breaks from treatment but worry about being excluded from treatment. Crucially, the organization of the FACT-inspired teams allows for flexibility in the intensity of visits and treatment. The norms of professionals also support users’ perspectives on COC, as the norms focus on building trust in the relations between users and professionals. Conclusions One important step to achieve more equal access is to integrate the social world of users. This requires organizational and professional approaches that allow for user needs for dis-continuity in COC. Key messages • For mental health service users, continuity-of-care includes breaks from treatment (discontinuity). • More equal health access requires adapting continuity-of-care to needs as perceived by users.

Monitoring the digital healthcare transition in the Netherlands: Challenges, achievements and future

Abstract Since 2013, the Netherlands Institute of Health Service Research, along with other Dutch research institutes, has monitored the digital healthcare transition in The Netherlands. Through annual surveys of both healthcare professionals (from primary and secondary care) and users (patients as well as the general population) from 2013 to 2023, trends in digital health utilization and experiences have been tracked. Overall, there has been a steady increase in digital care adoption since 2013, but in 2023, growth among professionals stabilized while slightly rising among users. Some tools saw significant increases, like automatic medicine dispensers and home monitoring, freeing up nurses’ time. Utilization patterns differ among patients according to their educational attainment and age, showing lower usage rates among older individuals and those with lower levels of education. Most professionals, especially nurses, view digital care positively, but they recognize its limitations in solving healthcare challenges entirely. Healthcare professionals believe it offers only a limited contribution to cost management, workload reduction, and job satisfaction and emphasize the need for seamless integration into routine care. User opinions are divided, with those with chronic conditions often expressing skepticism. Both professionals and patients agree that personal experience is crucial in determining its value. Additionally, ensuring user-friendliness and clarifying reimbursement for digital healthcare are essential. This workshop provides an overview of developments in the Netherlands and a discussion of challenges, achievements, and prospects. Particular attention will be paid to the monitoring of digitalization progress and effects, and the use of digital solutions in primary and secondary care.

Reflecting (on) power?Critical reflections by healthworkers in Germany on racial power and privilege

Abstract Background Healthcare users have increasingly reported on experiences of racial discrimination in healthcare encounters in Germany (Aikins et al. 2020). While research on the experiences of racialised users predominates, examining the perspectives of white professionals, especially those holding positions of authority, regarding their internalised stereotypes and discriminatory practices is also crucial. This study therefore investigated the prevalence of conscious or unconscious biases related to critical whiteness and anti-racism among healthcare workers (doctors, nurses and therapists) and how these attitudes shaped their professional practice. Methods Problem-centred expert interviews (Döringer 2021) with 20 healthcare professionals from medicine, nursing, and therapeutic professions working in hospitals or rehabilitation facilities across three German federal states. Data were analysed using documentary method (Bohnsack 2002). Results Respondents exhibited varying degrees of reflective abilities, and there are limited opportunities for structured self-reflection focused on recognizing and addressing racism. The research interview constituted a much-needed space for such reflection. Those who are sensitised about their own positions of privilege often are so due to external influences and personal trajectories (teenaged children, trade union activism) rather than through the values or structures of their institutions. Unconscious racism nonetheless still manifests, demonstrating the need to create more inclusive environments where critical self-reflection on racism is encouraged. Conclusions To effectively combat racism, German healthcare institutions must systematically implement anti-racist and intersectional interventions. This also entails creating spaces for reflection where staff can openly examine and acknowledge their own biases, fostering an environment conducive to collective action for promoting anti-racist workplace practices. Key messages • Opportunities for self-reflection critical of racism should also be offered across institutions in order to ensure trusting, non-hierarchical spaces. • Reflections on one’s own social positioning and privileges are not common in all circles, so the necessity of this attitude should be communicated in an error-friendly manner.

Face and content validity of the EMPOWER-UP questionnaire: a generic measure of empowerment in relational decision-making and problem-solving

BackgroundDecision-making and problem-solving processes are powerful activities occurring daily across all healthcare settings. Their empowering potential is seldom fully exploited, and they may even be perceived as disempowering. We developed the EMPOWER-UP questionnaire to enable assessment of healthcare users’ perception of empowerment across health conditions, healthcare settings, and healthcare providers’ professional backgrounds. This article reports the initial development of EMPOWER-UP, including face and content validation.MethodsFour grounded theories explaining barriers and enablers to empowerment in relational decision-making and problem-solving were reviewed to generate a preliminary item pool, which was subsequently reduced using constant comparison. Preliminary items were evaluated for face and content validity using an expert panel of seven researchers and cognitive interviews in Danish and English with 29 adults diagnosed with diabetes, cancer, or schizophrenia.ResultsA preliminary pool of 139 items was reduced to 46. Independent feedback from expert panel members resulted in further item reduction and modifications supporting content validity and strengthening the potential for generic use. Forty-one preliminary items were evaluated through 29 cognitive interviews, resulting in a 36-item draft questionnaire deemed to have good face and content validity and generic potential.ConclusionsFace and content validation using an expert panel and cognitive interviews resulted in a 36-item draft questionnaire with a potential for evaluating empowerment in user-provider interactions regardless of health conditions, healthcare settings, and healthcare providers’ professional backgrounds.

High-cost users still came to hospitals during the COVID-19 pandemic during first wave data in Thailand: secondary data analysis

BackgroundThe phenomenon of high-cost users (HCUs) in health care occurs when a small proportion of patients account for a large proportion of health care expenditures. By understanding this phenomenon during the COVID-19 pandemic, tailored interventions can be provided to ensure that patients receive the care they need and reduce the burden on the health system.ObjectivesThis study aimed to determine (1) whether the HCUs phenomenon occurred during the pandemic in Thailand by exploring the pattern of inpatient health expenditures over time from 2016 to 2021; (2) the patient characteristics of HCUs; (3) the top 5 primary diagnoses of HCUs; and (4) the potential predictors associated with being an HCU.MethodsThe secondary data analysis was conducted via inpatient department (IPD) e-Claim data from the National Health Security Office for the Universal Coverage Scheme, which provides health care to ~ 80% of the Thai population. Health care expenditure over time was calculated, and the characteristics of the population were examined via descriptive analysis. Multinomial logistic regression was applied to explore the potential predictors associated with being an HCU.ResultsThe characteristics of HCUs remained relatively the same from 2016 to 2021. In terms of the proportion of male (55%) to female patients (45%), the age ranged from 55 to 57 years, with an estimated 8-day length of hospital stay and 7 admissions per year, and the average health care cost per patient was ≥ USD 2,860 (100,000 THB). The low-cost users (LCUs) group (the bottom 50% of the population), had more female patients (55%), a younger age ranging from 27 to 33 years, a 3-day length of stay, 1‒2 admissions per year, and a lower average health care cost per patient, which was less than USD 315 (≤ 11,000 THB).ConclusionThe HCUs phenomenon still existed even with limited health care accessibility or lockdown measures implemented during the COVID-19 pandemic. This finding could indicate the uniqueness of the need for health services by HCUs, which differ from those of other population groups. By understanding the trends of health care utilization and expenditure, along with potential predictors associated with being an HCU, policies can be introduced to ensure the appropriate allocation of health resources to the right people in need of the right care during future pandemics.

Descriptive study of mental health care users 12 months pre- and post-COVID-19 lockdown.

Coronavirus disease 2019 (COVID-19) has impacted on a range of physical, mental and societal health indices. Increased levels of psychological stress are often reported following pandemics. To describe and compare the presentations of mental health care users pre- and post-initiation of the lockdown, with an emphasis on demographic profiles and final diagnoses. The study was conducted as a retrospective record review over the predetermined period at a large public hospital in Johannesburg and included all mental health care users requiring psychiatry consultation during the study period. Clinical records were traced via the emergency department registration desk, and information pertaining to demographics, presenting complaints, date of presentation and diagnosis was extracted. A significant increase was seen in patients with psychotic disorders from pre-COVID-19 to post-COVID-19. There was a reduction in presentations of mood disorders and substance-related disorders. Patients presenting in the post-COVID-19 time period were significantly younger than in the pre-COVID-19 time period. Pandemics result in notable negative mental health sequelae. Policies aimed at mitigating the spread of infective agents should be implemented with consideration of the burden of psychological distress following the pandemic. This study provides insights into clinical and demographic variables in a mental health care population serviced at a government hospital pre- and post-COVID-19 lockdown regulations.

Facilitating psychiatric nurses’ advocacy for mental healthcare users’ human rights in a primary healthcare setting: a conceptual framework

BackgroundEven though human rights advocacy is a part of mental health care, psychiatric nurses in South Africa’s primary healthcare (PHC) setting face substantial challenges when advocating for the rights of mental health care users (MHCUs). The study aimed to develop a conceptual framework to facilitate psychiatric nurses’ advocacy for mental healthcare users’ human rights in a PHC setting.MethodsA qualitative, exploratory, descriptive, and contextual design was used to investigate the psychiatric nurses’ experiences advocating for MHCUs’ human rights in a PHC setting. Three phases were followed: the empirical phase, the classification of concepts, and a development phase. Following the empirical phase, a conceptual framework was developed to facilitate psychiatric nurses’ advocacy for MHCUs human rights in a PHC setting.ResultsThree themes were derived from focus group interviews with psychiatric nurses in the empirical phase. These themes yielded the central concept as ‘the facilitation of empowerment’ of psychiatric nurses in advocating for MHCUs’ human rights. The central concepts were also classified. A conceptual framework was developed that included the relationship, working and termination phases.ConclusionThe study described the development of a conceptual framework to facilitate psychiatric nurses’ advocacy for mental healthcare users’ human rights in a PHC setting. Psychiatric nurses play a key role in advocating for the human rights of MHCUs. This task is important and should be implemented from the government to the societal level, including all stakeholders.

Legal abortion performed by pre-teens: primary health care workers’ perception and knowledge

This study aims to put into evidence Distrito Federal’s (DF) primary health care workers’ perception and knowledge regarding legal abortion, performed by 10 to 14 year old pre-teens. This is a descriptive study of qualitative approach. Semi-structured interviews were done to 17 primary health care workers currently working in Basic Health Units (BHU) of DF, under contract with DF’s Secretariat of Health. This article showed the worker’s lack of knowledge regarding legal abortion and specific care towards the age group, copying their knowledge regarding adults without adaptation for pre-teens. Workers’ personal beliefs influenced their practice and their choice to correctly inform Health Care users.

Preferences for Delivery of HIV Prevention Services Among Healthcare Users in South Africa: A Discrete Choice Experiment.

Progress has been made to scale oral pre-exposure prophylaxis (PrEP) as part of combination HIV prevention, with the WHO recommending differentiated, simplified and demedicalized approaches. This study explored user preferences for components of a PrEP service delivery package, through a discrete choice experiment (DCE) among 307 people accessing primary healthcare services in South Africa between November 2022 and February 2023. Attributes included were: Source of information about HIV prevention and PrEP; Site for PrEP initiation and follow-up; Frequency of follow-up; PrEP pick-up point; HIV testing whilst using PrEP; Contact between appointments. A D-efficient DCE design was created with 16 choice sets in 2 blocks. DCE data were analysed using generalised multinomial logistic models. Compared to printed materials, participants preferred getting information about PrEP online (aOR = 7.73, 95% CI = 5.13-11.66) and through WhatsApp (aOR = 2.23, 95% CI = 0.98-5.55). PrEP initiation at a pharmacy or mobile clinic was valued equally to initiating PrEP at a clinic, but a community pop-up site was less preferred (aOR = 0.46, 95% CI = 0.33-0.64). There was a preference for 6-monthly over 3-monthly follow-up (aOR = 11.88, 95% CI = 5.44-25.94). Participants preferred collecting PrEP from a pharmacy (aOR = 5.02, 95% CI = 3.45-7.31), through home delivery (aOR = 2.18, 95% CI = 1.26-3.78) and from a vending machine (aOR = 1.43, 95% CI = 1.02-1.99) relative to where they initiated PrEP. Participants also preferred HIV self-testing over a healthcare provider test (aOR = 5.57, 95% CI = 3.72, 8.36). WhatsApp or Facebook groups (aOR = 4.12, 95% CI = 3.00-5.67), monthly phone calls (aOR = 2.84, 95% CI = 1.73-4.67) and weekly messages (aOR = 1.47, 95% CI = 1.10-1.97) were preferred contact between appointments, relative to no contact. To meet users' preferences, there is a need to expand decentralised and self-led HIV prevention services.

75 - Assessment of the Brazilian Women’s Knowledge, Users of Primary Health Care, About Urinary Incontinence

75 - Assessment of the Brazilian Women’s Knowledge, Users of Primary Health Care, About Urinary Incontinence

Assessing willingness to pay for children's COVID-19 vaccination among healthcare providers and users using a theory-based discrete choice experiment

Improving vaccine coverage among children is crucial to prevent the long-term consequences of COVID-19 infections and the emergence of resistant COVID-19 variants, especially in resource-scarce settings. This study determined factors influencing the willingness to take and pay for COVID-19 vaccine for children among Vietnamese healthcare professionals and the public. A Theory-Based discrete-choice experiment was focused on a different topic related to vaccines, including the COVID-19 vaccine for children, Monkeypox, the adult COVID-19 booster, the HIV vaccine, and a potential future pandemic. The recruitment period was from April to August 2022, and a total of 5700 Vietnamese individuals aged 16 and above from various regions of the country participated in the study. The data for the sub-study on the COVID-19 vaccination for children was completed by 891 of these participants. Most participants agreed on vaccination for all children. Among healthcare professionals it was 76.2% and 69.3% for the general population. Healthcare professionals were the main source of vaccine information (70.7%). Payment options of 50%, 100%, and full subsidy were the most popular. Concerns about vaccine characteristics were associated with lower acceptance among healthcare professionals and the general public. The burden of historical medical expenses negatively correlated with willingness to pay for vaccination, while service satisfaction positively correlated with willingness to pay. To develop an effective vaccination program among children in Vietnam, providing accurate information and satisfying vaccine services, primarily through knowledgeable and professional healthcare providers, can improve the willingness to vaccinate and pay for the COVID-19 vaccine.

Evaluation of Home Healthcare Services By Service Providers and Users

Background: On May 15, 2017, the Turkish Ministry of Health transferred the coordination and delivery of home healthcare services from primary healthcare facilities to hospitals. Objective:This study aims to find out what the patients, their families, and home healthcare providers think about this organizational change that has been made to the service delivery process. Methods: In the quantitative research, the survey created using the results of qualitative research was administered to 396 individuals, comprising 322 patients or their relatives and 74 medical staff members. The survey's reliability was assessed using Cronbach's alpha coefficient, its validity was assessed using exploratory and confirmatory factor analyses, and the t-test was used to test the hypotheses. Results: Following the transfer of home health service delivery and coordination from primary healthcare institutions to hospitals, it was found that visit frequency-satisfaction, equity, monitoring-evaluation, and socio-economic support were the dimensions in which patients and their relatives participated more than healthcare personnel. However, compared to patients or patient relatives, healthcare personnel participate more in the areas of access to services, personnel-financial support, and private sector-security support. Conclusions: According to these findings, it is noteworthy that both groups have a much higher level of participation in issues that directly concern them. Thus, it is believed that improving the problems that clients and staff find objectionable will enhance home health services. Keywords: Home care; healthcare providers; healthcare users; primary healthcare; hospitals

Healthcare Provision for the LGBT Community: A Scoping Review of Service Providers and User Perspectives

Objective: This scoping review aimed to explore available literature on the knowledge, attitudes, and practices of healthcare professionals on providing care to the lesbian, gay, bisexual, or transgender (LGBT) community as well as the experiences and perspectives of the LGBT community on their healthcare. Material and Methods: The following electronic databases were searched in December 2020: MEDLINE/PubMed, CINAHL, Web of Science, ProQuest, SCOPUS, and Embase for English-language publications; from 2010 to 2020.Results: This review included 59 studies that were selected from 5,318 studies. This review revealed that there was an increase in publications regarding this topic across the world. This review identified four themes: (I) the current healthcare landscape for the LGBT community, (II) facilitators of and (III) barriers to healthcare access and utilization among the LGBT community, and (IV) varied facets of healthcare of relevance for LGBT healthcare users – communication, space, education and training, research, and policies.Conclusion: This review serves as a valuable compass for future researchers seeking areas for deeper exploration and understanding. Nevertheless, the limitations of the study underscore the significance of exercising caution when interpreting its findings concerning challenges within LGBT healthcare.

Transitions of care for people living with dementia – insights using linked data

Objective People living with dementia have increasing care needs as their condition progresses, and tend to be high users of health and aged care. Linked data provide an opportunity to better understand transitions between services, to enable quality and timely care. Approach The pilot study used a new multi-source enduring linked dataset to analyse the use of health and residential aged care by Australians living with younger onset dementia between 2011–2016. The subsequent study focused on movements between hospital and residential aged care for older Australians who were hospitalised in 2017. ResultsThe younger onset dementia cohort comprised 5,400 Australians aged 30–69. More than half (58%) the cohort had moved from the community into residential aged care by the end of the study period. Of these, 21% had a hospital stay while living in the community that ended with entry to residential aged care. This important transition point was analysed further using a dementia cohort of 79,000 people aged 65 and over. One in 4 people (23%) with dementia who were living in the community moved into residential aged care within 7 days of a hospital stay. This group spent 20 days longer in hospital than other older people. People living in aged care were less likely than those in the community to return to hospital during the following year. ConclusionsThese results can help inform planning of community-based dementia support services, improve coordination of care, and investigate sources of delay for people awaiting entry to aged care.

Workplace violence in three public sector emergency departments, Gauteng, South Africa: A cross-sectional survey

IntroductionWorkplace violence against healthcareworkers in Emergency Departments (EDs) is a global concern. The purpose of this study was to determine the prevalence and types of workplace violence in EDs. Methodsa cross-sectional survey was conducted in three public sector hospital EDs in Gauteng, South Africa. A self-administered, standardised online questionnaire developed by the World Health organization was used to collect data between March and November 2022. A total of 65 healthcareworkers which consisted of nurses (24) and doctors (41) participated in the study. ResultsThe prevalence of workplace violence was 73.8 % with verbal abuse being the most common type at 66 %. Eighty-two percent of the victims did not report the incident. Poor communication and lack of mutual respect among staff and healthcare users contributed to both physical and non-physical workplace violence. ConclusionWorkplace violence appears to be a common occurrence in EDs in the hospitals surveyed in Gauteng. It is regarded as a typical incident by respondents, and it is underreported. It has a direct negative impact on healthcareworkers and their working environment and indirectly on patients. Urgent attention from all stakeholders is needed to minimize the prevalence of these incidents.

Access to Decentralised Public Healthcare Service Delivery in Rural Areas of Lesotho

Despite being a basic right for all citizens of every country, access to healthcare has been a challenge for many people globally. However, the emergence of the COVID-19 pandemic has heightened the need for improvedhealthcare service delivery and access to healthcare globally. The need for improved access to healthcare is especially critical for developing countries as theywere the worst affected in terms of healthcare service delivery by the pandemic. This study, which sought to assess healthcare accessibility in rural areas of Lesotho, is relevant because Lesotho is a country with high poverty levels, and most of the poor people in Lesotho live in the rural areas. The study employed a quantitative design and sampled 200 healthcare users from the rural areas of Lesotho to measure the dimensions of access to healthcare (which refer to the affordability, availability, acceptability and accessibility / accommodation of healthcare) on a 5-point Likert-type scale. The study’s findings showed that healthcare affordability remains a barrier to access in rural Lesotho. This was followed by accessibility and accommodation, then acceptability and availability of healthcare in rural Lesotho. The study then made recommendations to guide health policy makers in Lesotho.

Identifying health and healthcare priorities in rural areas: A concept mapping study informed by consumers, health professionals and researchers

BackgroundIt is vital that health service delivery and health interventions address patients’ needs or preferences, are relevant for practice and can be implemented. Involving those who will use or deliver healthcare in priority-setting can lead to health service delivery and research that is more meaningful and impactful. This is particularly crucial in rural communities, where limited resources and disparities in healthcare and health outcomes are often more pronounced. The aim of this study was to determine the health and healthcare priorities in rural communities using a region-wide community engagement approach.MethodsThis multi-methods study was conducted in five rural communities in the Grampians region, Western Victoria, Australia. It involved six concept mapping steps: (1) preparation, (2) generation (brainstorming statements and identifying rating criteria), (3) structuring statements (sorting and rating statements), (4) representation of statements, (5) interpretation of the concept map and (6) utilization. Community forums, surveys and stakeholder consultations with community members and health professionals were used in Step 2. An innovative online group concept mapping platform, involving consumers, health professionals and researchers was used in Step 3.ResultsOverall, 117 community members and 70 health professionals identified 400 health and healthcare issues. Six stakeholder consultation sessions (with 16 community members and 16 health professionals) identified three key values for prioritizing health issues: equal access for equal need, effectiveness and impact (number of people affected). Actionable priorities for healthcare delivery were largely related to access issues, such as the challenges navigating the healthcare system, particularly for people with mental health issues; the lack of sufficient general practitioners and other health providers; the high travel costs; and poor internet coverage often impacting technology-based interventions for people in rural areas.ConclusionsThis study identified actionable health and healthcare priorities from the perspective of healthcare service users and providers in rural communities in Western Victoria. Issues related to access, such as the inequities in healthcare costs, the perceived lack of quality and availability of services, particularly in mental health and disability, were identified as priorities. These insights can guide future research, policy-making and resource allocation efforts to improve healthcare access, quality and equity in rural communities.