Critical social framework on the determinants of primary healthcare access and utilisation

This paper aims to contextualise ‘healthcare access and utilisation’ within its wider social circumstances, including structural factors that shape primary healthcare for marginalised groups. Mainstream theories often neglect complexities among the broader social, institutional and cultural milieus that shape primary healthcare utilisation in reality. A blended critical social framework is presented to highlight the recognition and emancipatory intents surrounding person, family, healthcare practice and society. Using the theoretical contributions of Habermas and Honneth, the framework focuses on power relationships, misrecognition/recognition strategies, as well as disempowerment/empowerment dynamics. To enable causal and structural analysis, we draw on the depth ontology of critical realism. The framework is then applied to the case of rural elderly women’s primary healthcare use in Bangladesh. Drawing on the literature, this article illustrates how a blended critical social perspective reveals the overlapping and complex determinants that affect primary healthcare utilisation, before concluding with the importance of situating healthcare access in sociocultural structures.

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Informal mobile phone use by marginalised groups in a plural health system to bridge healthcare gaps in Sierra Leone

Information Development ◽

10.1177/0266666920932992 ◽

2020 ◽

pp. 026666692093299

Author(s):

Steven Sam

Keyword(s):

Health System ◽

Sierra Leone ◽

Mobile Phones ◽

Primary Healthcare ◽

Digital Literacy ◽

Healthcare Access ◽

Network Connectivity ◽

Literacy Skills ◽

Health Seeking ◽

Marginalised Groups

The possibility to use mobile phones to provide affordable, effective and accessible healthcare solutions has continued to attract significant investments in the application of formal m-health schemes in Africa. However, while the formal m-health schemes in Africa are limited and benefited only a handful of people, a majority of individuals are using their own phones to create an informal m-health ecosystem in an attempt to bridge primary healthcare access gaps. This paper draws on qualitative data from a four-year (2012-2016) anthropological study involving marginalised groups in Sierra Leone to document these health-seeking practices along with the benefits and challenges they create in a complex plural health system. It argues that the informal integration of mobile phones into the plural health system offers opportunities for marginalised individuals to search and secure primary healthcare of their choices, but poor network connectivity, high out of pocket maintenance costs, low digital literacy skills, and the lack of policy to streamline and regulate the practices can promise the effectiveness of the informal m-health system. It concludes by offering suggestions for addressing these challenges in the Sierra Leone context.

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Primary healthcare utilisation by older Australians during the COVID ‐19 pandemic

Internal Medicine Journal ◽

10.1111/imj.15328 ◽

2021 ◽

Vol 51 (5) ◽

pp. 818-820

Author(s):

Jonathan D. Bartholomaeus ◽

Maria C. Inacio ◽

Helena Williams ◽

Steve L. Wesselingh ◽

Gillian E. Caughey

Keyword(s):

Primary Healthcare ◽

Healthcare Utilisation

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Why does healthcare utilisation differ between socioeconomic groups in OECD countries with universal healthcare coverage? A protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2021-054806 ◽

2021 ◽

Vol 11 (11) ◽

pp. e054806

Author(s):

Iris Meulman ◽

Ellen Uiters ◽

Johan Polder ◽

Niek Stadhouders

Keyword(s):

Systematic Review ◽

Healthcare Access ◽

Healthcare Utilisation ◽

Oecd Countries ◽

Primary Data ◽

Scientific Article ◽

Socioeconomic Groups ◽

Universal Healthcare ◽

Healthcare Coverage ◽

Universal Healthcare Coverage

IntroductionEven in advanced economies with universal healthcare coverage (UHC), a social gradient in healthcare utilisation has been reported. Many individual, community and healthcare system factors have been considered that may be associated with the variation in healthcare utilisation between socioeconomic groups. Nevertheless, relatively little is known about the complex interaction and relative contribution of these factors to socioeconomic differences in healthcare utilisation. In order to improve understanding of why utilisation patterns differ by socioeconomic status (SES), the proposed systematic review will explore the main mechanisms that have been examined in quantitative research.Methods and analysisThe systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and will be conducted in Embase, PubMed, Scopus, Web of Science, Econlit and PsycInfo. Articles examining factors associated with the differences in primary and specialised healthcare utilisation between socioeconomic groups in Organisation for Economic Co-operation and Development (OECD) countries with UHC will be included. Further restrictions concern specifications of outcome measures, factors of interest, study design, population, language and type of publication. Data will be numerically summarised, narratively synthesised and thematically discussed. The factors will be categorised according to existing frameworks for barriers to healthcare access.Ethics and disseminationNo primary data will be collected. No ethics approval is required. We intend to publish a scientific article in an international peer-reviewed journal.

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How men who have sex with men experience HIV health services in Kampala, Uganda

BMJ Global Health ◽

10.1136/bmjgh-2019-001901 ◽

2020 ◽

Vol 5 (4) ◽

pp. e001901

Author(s):

Rachel King ◽

Zubayiri Sebyala ◽

Moses Ogwal ◽

George Aluzimbi ◽

Rose Apondi ◽

...

Keyword(s):

Hiv Prevention ◽

Health Services ◽

Healthcare Access ◽

Healthcare Services ◽

Sub Saharan Africa ◽

Health Staff ◽

Structural Factors ◽

Structural Barriers ◽

Sub Saharan ◽

Sex With Men

In sub-Saharan Africa, men who have sex with men (MSM) are socially, largely hidden and face disproportionate risk for HIV infection. Attention to HIV epidemics among MSM in Uganda and elsewhere in sub-Saharan Africa has been obscured by repressive governmental policies, criminalisation, stigma and the lack of basic epidemiological data describing these epidemics. In this paper, we aim to explore healthcare access, experiences with HIV prevention services and structural barriers to using healthcare services in order to inform the acceptability of a combination HIV prevention package of services for men who have sex with men in Uganda. We held focus group discussions (FGDs) with both MSM and healthcare providers in Kampala, Uganda, to explore access to services and to inform prevention and care. Participants were recruited through theoretical sampling with criteria based on ability to answer the research questions. Descriptive thematic coding was used to analyse the FGD data. We described MSM experiences, both negative and positive, as they engaged with health services. Our findings showed that socio-structural factors, mediated by psychological and relational factors impacted MSM engagement in care. The socio-structural factors such as stigma, homophobia and policy issues emerged strongly as did the mediating factors such as relations with specific health staff and a social support structure. A combination intervention addressing structural, social and psychological barriers could have an impact even in the precarious policy environment where this study was conducted.

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