Health and Health Care Access Barriers Among Transgender Women Engaged in Sex Work: A Synthesis of U.S.-Based Studies Published 2005–2019

Background Video-based health care can help address access gaps for patients and is rapidly being offered by health care organizations. However, patients who lack access to technology may be left behind in these initiatives. In 2016, the US Department of Veterans Affairs (VA) began distributing video-enabled tablets to provide video visits to veterans with health care access barriers. Objective This study aimed to evaluate veterans’ experiences with VA-issued tablets and identify patient characteristics associated with preferences for video visits vs in-person care. Methods A baseline survey was sent to the tablet recipients, and a follow-up survey was sent to the respondents 3 to 6 months later. Multivariate logistic regression was used to identify patient characteristics associated with preferences for care, and we examined qualitative themes around care preferences using standard content analysis methods for coding the data collected in the open-ended questions. Results Patient-reported access barriers centered around transportation and health-related challenges, outside commitments, and feeling uncomfortable or uneasy at the VA. Satisfaction with the tablet program was high, and in the follow-up survey, approximately two-thirds of tablet recipients preferred care via a tablet (194/604, 32.1%) or expressed that video-based and in-person care were “about the same” (216/604, 35.7%), whereas one-third (192/604, 31.7%) indicated a preference for in-person care. Patients were significantly more likely to report a preference for video visits (vs a preference for in-person visits or rating them “about the same”) if they felt uncomfortable in a VA setting, reported a collaborative communication style with their doctor, had a substance use disorder diagnosis, or lived in a place with better broadband coverage. Patients were less likely to report a preference for video visits if they had more chronic conditions. Qualitative analyses identified four themes related to preferences for video-based care: perceived improvements in access to care, perceived differential quality of care, feasibility of obtaining necessary care, and technology-related challenges. Conclusions Many recipients of VA-issued tablets report that video care is equivalent to or preferred to in-person care. Results may inform efforts to identify good candidates for virtual care and interventions to support individuals who experience technical challenges.

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Barriers to accessing health-care services: A qualitative study of migrant construction workers in a Southwestern Indian city

10.21203/rs.3.rs-16097/v1 ◽

2020 ◽

Author(s):

Maija Santalahti ◽

Kumar Sumit ◽

Mikko Perkiö

Keyword(s):

Health Care ◽

Health Services ◽

Health Care Access ◽

Access To Health Care ◽

Health Care Services ◽

Construction Workers ◽

Care Access ◽

Care Services ◽

Access To Health ◽

Health Care Access Barriers

Abstract Background: This study examined access to health care in an occupational context in an urban city of India. Many people migrate from rural areas to cities, often across Indian states, for employment prospects. The purpose of the study is to explore the barriers to accessing health care among a vulnerable group – internal migrants working in the construction sector in Manipal, Karnataka. Understanding the lay workers’ accounts of access to health service can help to comprehend the diversity of factors that hinder access to health care. Methods: Individual semi-structured interviews involving 15 migrant construction workers were conducted. The study applied theory-guided content analysis to investigate access to health services among the construction workers. The adductive analysis combined deductive and inductive approaches with the aim of verifying the existing barrier theory in a vulnerable context and further developing the health-care access barrier theory. Results: This study’s result is a revised version of the health-care access barriers model, including the dimension of trust. Three known health-care access barriers – financial, cognitive and structural, as well as the new barrier (distrust in public health-care services), were identified among migrant construction workers in a city context in Karnataka, India.Conclusions: Further qualitative research on vulnerable groups would produce a more comprehensive account of access to health care. The socioeconomic status behind access to health care, as well as distrust in public health services, forms focal challenges for any policymaker hoping to improve health services to match people’s needs.

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