Utilization Of Formal Services Research Articles

Support for Family Caregivers: Implications of Work Strain and Its Intersections With Formal and Informal Help.

This study seeks to assess whether and to what extent caregiver work strain is ameliorated by the presence of additional family caregivers and formal service use. Building on the stress process model and stress-appraisal moderation, we examine how formal and informal support varies in associations with caregiver distress for men and women. This study utilizes data provided by the National Study of Caregiving, which is linked with care-recipient information from the National Health and Aging Trends Study. Using panel methods for the pooled waves, we estimated caregiver outcomes of emotional well-being on the intersection of experiences of work strain and (a) the number of additional caregivers and (b) utilization of 6 different types of formal support. Additional informal caregivers for each respective care recipient are associated with lower levels of distress, although utilization of formal services (paid help and Medicaid funding) is positively associated with caregiver distress. Informal support can offset the impact of work strain, but interactions are only evident for women caregivers. The findings suggest that informal support, exemplified by the number of additional caregivers, corresponds with reduced emotional distress among employed caregivers and can mitigate the negative impacts of work strain. However, positive associations between formal support and male and female caregiver distress suggest that the context of formal services may offer limited or untimely support. This study is expected to broaden our understanding of informal caregiving in later life and provide practical implications on how to sustain informal care.

Health-related quality of life in family caregivers of autistic adults.

Family members of autistic individuals often provide support for their autistic relative throughout the lifespan which can lead to massive burden themselves. Reduced health-related Quality of Life (HRQoL) in family caregivers is assumed; however, only a handful studies on the HRQoL of family caregivers providing care to adult relatives exist as opposed to autistic children. Thus, the current study aimed to (i) investigate the current state of physical and mental HRQoL of family caregivers of autistic adults compared to the general population, and (ii) examine caregiver-related (e.g., age, subjective caregiver burden) and care recipient-related variables (e.g., symptom severity, utilization of formal services) explaining variance in the caregivers' HRQoL. N = 149 family caregivers completed a nationwide online survey, including the Short-Form Health Survey (SF-8) in order to assess the HRQoL. T-tests were used to compare the HRQoL of family caregivers with the general population. Bivariate correlational and multiple linear regression analyses were conducted in order to identify predictors explaining variance in family caregivers' HRQoL. Family caregivers of autistic adults reported significantly lower physical (M = 46.71, SD = 8.72, Cohen's d = 0.42) and mental HRQoL (M = 40.15, SD = 11.28, Cohen's d = 1.35) compared to the general population. Multiple linear regression with the mental HRQoL as the outcome showed a significant model (F(11, 95) = 5.53, p < .001, adj. R2 = .32) with increased subjective burden explaining most of the variance in mental HRQoL (ß = .32, GDW = .141, p < .001). Multiple linear regression analysis with the outcome physical HRQoL did not reveal a statistically significant model (F(11,95) = 1.09, p = .38). However, bivariate analyses also showed a positive correlation with the subjective caregiver burden (r= .20, p < .05). Findings highlight the need to consider HRQoL (and caregiver burden) of family caregivers of autistic adults in several healthcare settings to monitor a potential comprised health status in early stages, with the long-term goal to improve family caregivers' HRQoL.

Formal support services and (dis)empowerment of domestic violence victims: perspectives from women survivors in Ghana

BackgroundAs part of efforts to prevent violence against women, several countries have institutionalized formal support services including legislations to prevent, protect victims, and deter perpetrators of domestic violence (DV). Prior research on formal support service utilization shows that DV survivors do not get the necessary services they deserve. However, much remains to be known about the experiences of women survivors of DV who accessed a range of formal support services and how their experiences (dis)empowered them. Here, we assessed the experiences of Ghanaian women survivors of DV with formal support services vis-à-vis the provisions of the Ghana DV Act and insights of subject experts.MethodsFrom May to August 2018, we recruited a total of 28 participants: 21 women survivors of DV in Weija-Gbawe Municipality of Ghana, and 7 experts from the police, human rights, and health professions. We used two sets of in-depth interview guides: one to collect data on survivors’ experiences, and the second for the insights of experts. We performed summary descriptive statistics on survivors’ sociodemographic characteristics and used thematic analysis to assess their experiences of DV; and access to, patronage, and response of formal support services.ResultsOf 21 DV survivors, 19 (90.1%) were aware of the existence of the DV law, however none was well informed of their entitlements. DV survivors have low formal education and are not economically empowered. Some DV survivors are revictimized in the process of accessing formal services. DV survivors expect the government to provide them with shelter, upkeep, medical, and legal aid. All the 21 survivors had at least one contact with a women’s rights organization and were knowledgeable of their supporting services namely legal services, temporary shelter, and psychosocial support.ConclusionsThe experiences of DV survivors do not reflect the legal provisions of Ghana’s DV Act. Government under funding of formal services and negative gender norms are disempowering to survivors. NGOs are popular among women survivors of DV in Ghana for the education, legal, and material support they provide. A close collaboration between the government and NGOs could better mitigate DV in Ghana.

Utilization of Long-Term Care Services and the Role of Institutional Trust in South Korea

ABSTRACT With population aging, governments have become increasingly involved in the administration, funding, and regulation of formal long-term care (LTC) systems. We examine the association between institutional trust and formal LTC service utilization among older adults aged ≥60 years with care needs in South Korea’s public LTC scheme. Using data from the Korean Longitudinal Study of Aging and hierarchical logistic regressions, we evaluate the respective roles of trust in government and trust in the LTC program on service utilization. Results show that trust in the LTC scheme is significantly associated with service utilization: a unit increase in the level of trust is associated with a 29% increase in the odds of service use on average, controlling for need-related factors (e.g., chronic conditions) and other covariates. Furthermore, the positive relationship between trust and LTC utilization increases in magnitude with age. Older adults who are aged 80 and above, unmarried, with more ADL limitations, with psychiatric disease, or with arthritis are more likely to utilize formal LTC services. Our findings are robust to variations in sample inclusion criteria. Policymakers and health administrators should pay attention to building and maintaining institutional trust in public LTC schemes through good governance and other relevant strategies.

Examining Utilization of Formal Supports and Related Impacts on Overall Well-Being Among East Asian American Family Caregivers of Persons With Dementia: A Mixed-Methods Study.

Although East Asian American family caregivers are known to underutilize formal support services, there is a lack of evidence regarding the associations of formal service utilization with caregivers' well-being. This study examined the prevalence of different types of home-and community-based formal service utilization among Korean and Chinese American family caregivers of persons with dementia and how utilization of such services was associated with their well-being. We also explored their overall experience in accessing and utilizing formal dementia support services and programs. We employed a convergent mixed-methods study design. In a convenience sampling method, we recruited 62 family caregivers. Logistic regression and thematic analysis were utilized to analyze data. The results showed in-home services were mostly utilized among family caregivers of these ethnic groups. Out of 9 different support services, those who utilized nutrition programs and case management were more likely to report higher overall well-being. Four themes were developed: (1) awareness of formal support services but uncertainty on how to access them, (2) language barriers imposing additional challenges in accessing formal support services, (3) traveling to access culturally appropriate services, and (4) desire for culturally tailored medical and long-term care services. Findings from this study suggest the importance of case management services to overcome barriers to accessing and utilizing a wide range of formal support services and provision of culturally appropriate food in formal support services to increase East Asian American family caregivers' utilization of long-term care services.

Abstract WP86: Racial Disparities In Post-acute Service Utilization In The United States After Intracerebral Hemorrhage

Introduction: Intracerebral hemorrhage is a leading cause of long-term disability. Survivors often require significant post-acute care to enhance recovery and decrease disability. Racial/ethnic disparities in hospital discharge destinations can affect patient outcomes and population health. Methods: Data were obtained from the 2017 and 2018 National Inpatient Sample from the Healthcare Cost and Utilization Project. Patients with intracerebral hemorrhage who were admitted directly from the emergency department were included. Discharge destinations were classified as: Home/Routine (home without home health care); Home Health Care (HHC); and Facility (inpatient rehabilitation or skilled nursing facility). Survey-weighted binomial and multinomial logistic regressions were used to examine associations of race/ethnicity with discharge to one pathway versus others, adjusting for age, sex, neighborhood income, insurance status, comorbidities, proxies of stroke severity, and hospital characteristics. Results: The study included 91435 weighted admissions for intracerebral hemorrhage with a racial distribution of 59.7% Whites, 20.9% Hispanics, 21.4% Asian/Pacific Islanders, and 19.7% Blacks. In-hospital mortality was 22.9%, while 18.1% of patients were discharged to Home/Routine, 9.7% to HHC, and 45.1% to a Facility. Hispanics were most likely to be discharged to Home/Routine (24.0%) and least likely to be discharged to a facility (38.7%). Compared to non-Hispanic Whites, other race-ethnic groups had lower odds of being discharged to a facility over home with or without homecare services with the lowest odds amongst Hispanics (adjusted OR, 0.72; 95% CI, 0.70-0.73), followed by Asians/Pacific Islanders (adjusted OR, 0.76, 95% CI, 0.73-0.78), and Blacks (adjusted OR, 0.95; 95% CI, 0.94-0.97). Conclusion: Patients of non-white race-ethnicity admitted with intracerebral hemorrhage are less likely to be discharged to a facility (inpatient rehabilitation or skilled nursing facility) than their white counterparts. The lowest rate of facility discharge was seen among Hispanics. Whether lower formal post-acute service utilization result in worse post-stroke outcomes requires further studies.

Improving health and social care services for slum-dwelling older adults: Perspectives of health professionals.

BackgroundBesides confronting the challenges of a growing older population, developing countries are dealing with limited resources and infrastructure, to ensure good health and social care services. One of these developing countries facing these challenges is Ghana. The healthcare system in Ghana currently does not have specialized geriatric services and is funded through the National Health Insurance Scheme (NHIS), private insurance companies and an out-of-pocket expenditure system. Social care services are important in improving Quality of Life (QoL) as it helps in building and strengthening relationships while also keeping slum-dwelling older adults active. There are various challenges with the health and social care of older adults in slums and practical ways to improve these have not been explored among the providers of this care.AimsThis study, therefore, aimed to explore (1) the views of health professionals on older slum-dwelling adults' health and social care needs, access, and use, and (2) recommendations for improving access to health and social care services among slum-dwelling older adults.MethodA qualitative exploratory descriptive approach was used among health professionals by conducting a focus group discussion (FGD) and interviews. A semi-structured interview guide was used to collect data from each participant.ResultsA total of 27 participants took part in the study. In the analysis of transcripts, 3 themes and 14 subthemes were conceptualized. Financial difficulties, queueing issues, distance to health facilities, health illiteracy and negative attitude of health professionals were identified as some barriers to the utilization of formal healthcare services. Social care services were described as non-existent, not structured, and having limited resources to cater for attendants. The health professionals also provided recommendations for improvement.ConclusionHealth professionals in this study discussed barriers to access and use of health and social care services. Addressing these barriers is essential to improve the use of formal health and social care services and diminish health inequity among older adults.

Impact of ethnicity on parental health outcomes and experiences after paediatric intensive care unit discharge: a mixed-methods systematic review.

The impact of ethnicity on parental health outcome after paediatric intensive care unit (PICU) discharge remains unclear. Thirteen medical and healthcare databases, unpublished studies and grey literature were searched up to November 5, 2021. We performed a mixed-method systematic review to understand the impact of ethnicity on parental outcomes after PICU discharge, including eight quantitative and eight qualitative studies. Among 1529 parents included, 1064 (72%) were White. Higher prevalence of post-traumatic stress disorder was seen in Black parents (17% White vs 36% Black, p = .03). Latino ethnicity was found to have protective effect against anxiety as compared to White parents (coefficient - 4.27, p < .001). A total of 91 findings were aggregated into 14 categories, and the five synthesized themes from the eight qualitative studies were long-term psychological impact after PICU, use of coping strategies, challenges of re-integration, changes in relationships and the utilization of formal support services and resources. Mixed-method synthesis found that parents of ethnic minority group were underrepresented (18%) and had higher attrition rates in a longitudinal study as compared to White parents following childhood critical illness. Conclusion: There are significant gaps in evidence related to the impact of ethnicity on long-term parental health outcomes after PICU discharge. Ethnic diversity and inclusiveness in long-term PICU research may aid understanding of the parental experiences and outcomes to close the gap in health disparity.

Organizational Bias in Gender-Based Violence Research

Relatively few victims of gender-based violence (GBV) seek help from nonprofit organizations, healthcare providers, or law enforcement agencies, choosing instead to disclose to friends and family or to nobody at all. This article presents a systematic review of GBV research in sociology showing that, despite low rates of formal service utilization, 68% of published articles use data from organizations including social service providers, hospitals, and police stations and courts. While data from organizations are essential for understanding the experiences of people who report to them, they may not be generalizable to victims broadly. Victims who seek formal help may differ from those who do not in their relative social advantage—along lines of race, socioeconomic status, gender identity, and more—and in their understandings of and responses to violence. We discuss how more non-organizational research might broaden our understanding of violence experienced by society’s most marginalized, elucidate ways to make formal organizational responses more inclusive, and sensitize stakeholders in the anti-GBV movement to interventions outside of the therapeutic and carceral state.

Family Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service Use.

Background and ObjectivesResidents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the United States. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, underresourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia.Research Design and MethodsThe study was grounded in the Andersen Behavioral Model, supplemented with culturally relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver’s rural community identity and attitude toward services were moderators.ResultsApproximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services.Discussion and ImplicationsAlthough the extent of needs and the caregiver’s economic situation were essential influences on formal service utilization, the main drivers were the caregiver’s identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.

Family Caregivers and Support: Implications for Work Strain and Formal Service Use

In the US, many employed caregivers make professional adjustments, exacerbating already tenuous balances between work and life. Using the framework of the Stress Process Model (SPM), current research examines the sources of support (both formal and informal) and the contextual factors that facilitate or impede caregiver support. In this research, we examine whether and to what extent caregiver work strain is ameliorated by the presence of additional family caregivers and formal service use. This study utilizes data provided by the National Study of Caregiving (NSOC) data. Using panel methods for the pooled waves, we analyze the associations between work-strain and the number of additional caregivers with utilization of formal support (such as paid service support). Preliminary analyses align with the Stress Process Model as additional caregivers for each respective care-recipient is associated with lower levels of work strain. On the other hand, utilization of formal services (paid help and Medicaid funding) is positively associated with work strain. These findings suggest that the number of additional caregivers can reduce the negative impact of caregiving on work related strain among employed caregivers. That is, multiple caregivers may be more reflective of cooperative arrangements which offset work disruptions that occur with the onset of caregiving. In addition, formal sources may more frequently be used as a last resort to address caregiver burnout. Ongoing analyses are examining changes in the number of caregivers and its impact on disruptive work event, which could lead to financial outcomes for caregivers.

Caregiving management styles and utilization of formal care services among dementia caregivers

AbstractBackgroundWhile dementia caregivers report need for assistance, formal service utilization remains low (apprx. 25%). Research suggests demographic characteristics associated with service use, but caregivers’ cognitive and behavioral approach to care has not been considered. Prior work by this team has identified five distinct caregiving styles through qualitative analysis: “Externalizers” (superficial understanding, self‐focused, anger, frustration), “Individualists” (go it alone, emotionally removed), “Learners” (recognize need to change approach but stuck, emotionally turbulent), “Nurturers” (positive affect, empathy, natural mastery), and “Adapters” (arsenal of acquired management strategies, adaptable). We examine variation in formal care service utilization of the caregiving styles and hypothesize that styles showing greater adaptation to the care role (Adapters, Nurturers) will be more likely to utilize formal care services. We also explore reported barriers to use of formal services among those caregivers reporting non‐use.MethodParticipants included 100 primary caregivers for a person living with dementia (PLwD) who were 64 years old on average, 74% female, and 18% non‐White. Use (vs. non‐use) of formal services was a dichotomous outcome in a logistic regression with caregiving style classifications as the key predictors also adjusting for caregiver demographics, length of care, co‐residence, and dementia severity.ResultRates of service utilization varied by caregiving style (20%‐70%). Relative to nurturers (style least likely to use formal services), adapters had greater odds of utilizing formal services (OR=14.4, 95% CI= 1.8‐115.1). Additionally, caregivers who were older and providing care for a PLwD with greater dementia severity had greater odds of formal service use, while caregivers living with the PLwD reported lower odds of service use. Among those not using services, there were not significant differences in barriers to use (e.g. expense) across styles, however, over half cited not needing the assistance.ConclusionBeing an Adapter was significantly associated with service use suggesting that certain caregivers may have greater comfort in accessing such services. Styles showing less adaptability and more rigidity in care approach (e.g. Externalists, Individualists) may not recognize need for formal supports or benefit from support in selecting assistance that meets their needs. Future work may consider measuring for caregiving styles before making service recommendations.

Young Carers in Australia: Understanding Experiences of Caring and Support-Seeking Behaviour

ABSTRACT Although young carers experience several challenges associated with their roles, little is known about the current effects of those challenges on their education, work, and social life. Their support-seeking behaviour is also under-researched. Based on findings from 25 interviews and a focus group discussion, this qualitative study presents insights into the effects of providing informal care on the lives of young carers and their support-seeking behaviour. Participants reported several physical, mental, and social effects of caring that have either positive or negative implications for their lives. Whereas providing care influenced early maturity, self-efficacy, and formation of stronger bonds with care recipients, it also limited participants’ ability to find work, focus on their education, and socialise with peers. Utilisation of formal community-based and professional support services was low among the participants. Stigma associated with the label “carer”; lack of youth-friendly service settings; lack of self-identification of carer status; and a lack of cultural, age, and specific support services for different stages of caring constrained the use of support services among participants. In contrast, positive attitudes of service providers encouraged the use of support services. These findings highlight an urgent need for more professional support for young carers. IMPLICATIONS Failure to provide sufficient professional support to young carers can aggravate the negative consequences associated with their caring roles. Social workers and other professionals can strengthen their collaboration with educators, work supervisors, and other support agencies to address the challenges of providing care at a young age. Given that caring roles often influence early maturity and self-efficacy for young carers, social workers and other professionals can consider using strength-based approaches in addressing challenges associated with providing care, including those related to support-seeking behaviour.

Self-Reported Preferences for Help-Seeking and Barriers to Using Mental Health Supports Among Internal Medicine Residents: Exploratory Use of an Econometric Best-Worst Scaling Framework for Gathering Physician Wellness Preferences.

BackgroundBurnout interventions are limited by low use. Understanding resident physician preferences for burnout interventions may increase utilization and improve the assessment of these interventions.ObjectiveThis study aims to use an econometric best-worst scaling (BWS) framework to survey internal medicine resident physicians to establish help-seeking preferences for burnout and barriers to using wellness supports by quantifying selections for 7 wellness support options and 7 barriers.MethodsInternal medicine resident physicians at our institution completed an anonymous web-based BWS survey during the 2020-2021 academic year. This cross-sectional study was analyzed with multinomial logistic regression and latent class modeling to determine the relative rank ordering of factors for seeking support for burnout and barriers to using wellness supports. Analysis of variance with Tukey honest significant difference posthoc test was used to analyze differences in mean utility scores representing choice for barriers and support options.ResultsOf the 163 invited residents, 77 (47.2% response rate) completed the survey. Top-ranking factors for seeking wellness supports included seeking informal peer support (best: 71%; worst: 0.6%) and support from friends and family (best: 70%; worst: 1.6%). Top-ranking barriers to seeking counseling included time (best: 75%; worst: 5%) and money (best: 35%; worst: 21%).ConclusionsOverall, our findings suggest that low utilization of formal mental health support is reflective of resident preferences to seek help informally and that increasing utilization will require addressing pragmatic barriers of time and cost. Assessing physician preferences for wellness-related initiatives may contribute to understanding the low utilization of formal mental health services among physicians, which can be determined using a BWS framework.

Mobile money and healthcare use: Evidence from East Africa

This paper uses a difference-in-difference framework to estimate the effects of mobile money transfer technology (MMT) on healthcare use in the face of negative health shocks. We use survey data from 2013 to 16 with quarterly observations on about 1800 households of 10 villages in the Kisumu region of Western Kenya. We find evidence that MMT, likely through greater ease of informal borrowing, helps households increase utilization of formal healthcare services in terms of visits to a clinic, consultation and medication expenditures in comparison with non-users of this technology. MMT appears to be complementary with other risk-sharing mechanisms such as farm sales and in-kind transfers.

Socio-Economic Factors and Utilization of Formal Financial Services among smallholder Farmers in Kenya.

The main aim of this research was to establish the effect of socio-economic factors on utilization of formal financial services among smallholder farmers in Kenya. Farmers in low-income counties encounter a number of challenges among them limited access to finance. Financing agriculture, therefore, becomes a critical service to enable the full realization of the sector’s potential. In Kenya, the advent of innovative banking models through commercial banks such as Equity bank have seen a higher proportion of the rural population who were previously unreached being reached by financial services. That said, the subscription to formal financial services by small holder farmers is still low and many of them either shy away from formal financial institutions or are simply ineligible for the services due to lack of a banking profile with the institutions. Cross-sectional survey research design was adopted. The target population for this study were smallholder farmers from Nakuru, Busia and Kirinyaga Counties in Kenya. The study sample was determined using simple random sampling. The sample size was 560 smallholder farmers. The questionnaire and secondary information were the key instruments for data collection. Quantitative data was analysed using multiple linear regression equations with the aid of SPSS software. The study established that the socio-economic factors significantly affected utilization of formal financial services by the smallholder farmers in the country. Policy Makers should therefore, encourage small holder farmers by way of incentives to disclose their annual income so as to improve their chances of accessing formal financial services that can expand their enterprises.

Demographic Factors Influencing the Adoption of Mobile Phones in the Utilization of Formal Financial Services by Smallholder Farmers in Kenya

The study aimed at assessing the demographic factors influencing adoption of mobile phones in the utilization of formal financial services by smallholder farmers in Kenya. Financial access household survey showed that 80 percent of Kenyan adults own a formal bank account. Whilst significant advances have been made in financial technology products, their penetration and usage among smallholder farmers in utilizing financial services and particularly the demographic factors influencing them remains unestablished. Research into more innovative, intermediated solutions, effective participation and inclusion of appropriate community-based groups in mobile financial services is, therefore, necessary. The target population for this study were smallholder farmers from Nakuru, Busia and Kirinyaga Counties in Kenya. Simple random sampling and Convenience sampling techniques were used to select 496 smallholder farmers as respondents for the study. Data was collected using copies of a researcher developed questionnaire and data collection sheet. Quantitative data was analysed using multiple linear regression analysis with the aid of SPSS software. The findings revealed that demographic factors were important in predicting mobile phone utilization for formal financial services among smallholder farmers in Kenya. Therefore, the study recommends that mobile phone mobile service providers should collaborate with financial service providers to enable the farmers upgrade their phones to access more financial services platforms.

Factors related to excessive out-of-pocket expenditures among the ultra-poor after discontinuity of PBF: a cross-sectional study in Burkina Faso

BackgroundMeasuring progress towards financial risk protection for the poorest is essential within the framework of Universal Health Coverage. The study assessed the level of out-of-pocket expenditure and factors associated with excessive out-of-pocket expenditure among the ultra-poor who had been targeted and exempted within the context of the performance-based financing intervention in Burkina Faso. Ultra-poor were selected based on a community-based approach and provided with an exemption card allowing them to access healthcare services free of charge.MethodsWe performed a descriptive analysis of the level of out-of-pocket expenditure on formal healthcare services using data from a cross-sectional study conducted in Diébougou district. Multivariate logistic regression was performed to investigate the factors related to excessive out-of-pocket expenditure among the ultra-poor. The analysis was restricted to individuals who reported formal health service utilisation for an illness-episode within the last six months. Excessive spending was defined as having expenditure greater than or equal to two times the median out-of-pocket expenditure.ResultsExemption card ownership was reported by 83.64% of the respondents. With an average of FCFA 23051.62 (USD 39.18), the ultra-poor had to supplement a significant amount of out-of-pocket expenditure to receive formal healthcare services at public health facilities which were supposed to be free. The probability of incurring excessive out-of-pocket expenditure was negatively associated with being female (β = − 2.072, p = 0.00, ME = − 0.324; p = 0.000) and having an exemption card (β = − 1.787, p = 0.025; ME = − 0.279, p = 0.014).ConclusionsUser fee exemptions are associated with reduced out-of-pocket expenditure for the ultra-poor. Our results demonstrate the importance of free care and better implementation of existing exemption policies. The ultra-poor’s elevated risk due to multi-morbidities and severity of illness need to be considered when allocating resources to better address existing inequalities and improve financial risk protection.

Mediating Effects of Financial Innovations between Behavioral Factors and Financial Inclusion of Micro Enterprises in Kenya

Purpose: Understanding the mediating role of the adoption of financial innovations on the relationship behavioral factors and utilization of formal financial services was the main aim of this research. The behavioral factors examined were self-control, confidence and social proof. The study is premised on behavioral finance theories.&#x0D; Design/Methodology: The positivist approach and explanatory research designs were adopted to understand the relationships between the variables under investigation. A sample of 486 owners/managers of licensed micro-enterprises in Nairobi, Kenya were selected using stratified random sampling technique. Primary data was collected through a structured questionnaire. Hypotheses were tested using Hayes and Zhao approach for mediation analysis.&#x0D; Findings: The results showed that financial innovations mediated the relationship between each of the behavioral factors and financial inclusion, that is; self- control (β =.0941, ρ= .00), confidence; (β = .1019, ρ = .00) and social proof (β = .1036, ρ = .00). &#x0D; Practical implications: The study has brought into fore the mediating role of financial innovations on the relationship between the three behavioral factors and financial inclusion. Thus, practitioners are encouraged give due attention to behavioral factors and financial innovations in policy formulation and programs geared towards optimal utilization of financial services.

Exploring the association between sick child healthcare utilisation and health facility quality in Malawi: a cross-sectional study

ObjectiveIncreasing the availability of basic healthcare services in low-and middle-income countries is not sufficient to meet the Sustainable Development Goal target for child survival in high-mortality settings, where healthcare utilisation...