A multidimensional study of public satisfaction with the healthcare system: a mixed-method inquiry in Ghana

Abstract Background Many governments in sub-Saharan Africa have recently sought to improve their health systems by increasing investment in healthcare facilities and introducing social insurance programmes. However, little is known about the impact of these intended improvements on public perceptions about the healthcare systems. This article examines whether and why people of different socioeconomic and ideological backgrounds are satisfied (or not) with the current healthcare system in Ghana from a social ecological perspective. Method Data were elicited from a cross-sectional mixed-method study conducted in four regions in Ghana in 2018. We used ordinal logistic regression and thematic analysis techniques to analyse the data. Results Satisfaction with the healthcare system was generally low. From our quantitative study, intrapersonal factors (e.g., being older and having good health and well-being status); interpersonal factors (e.g., linking social capital); community factors (e.g., living in rural areas); and organisational and public policy factors (e.g., trust in the health system, favouring welfare policies, and being interested in politics) were positively associated with satisfaction with the healthcare system. These were corroborated by the qualitative study, which showed that poor attitudes of health personnel, financial constraints, perceived poor health facilities, and perceived inefficacy of services contribute to dissatisfaction with the healthcare system. Conclusion Strategies to improve satisfaction with the healthcare system in Ghana should incorporate ecological perspectives by considering factors such as demographic profile, health needs, political orientation, issues of trust in the healthcare system, and the dynamics and impact of social relationships of populations concerned.

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(Un)Healthy Lifestyles, Environment, Well-being and Health Capability in Rural Neighbourhoods: A Community-based Cross-sectional Study

10.21203/rs.3.rs-98459/v1 ◽

2020 ◽

Author(s):

Anabela Marisa Azul ◽

Ricardo Almendra ◽

Marta Quatorze ◽

Adriana Loureiro ◽

Flávio Reis ◽

...

Keyword(s):

Mixed Method ◽

Rural Areas ◽

Well Being ◽

Cross Sectional Study ◽

P Value ◽

Community Based ◽

Cross Sectional ◽

Health Loss ◽

Mixed Method Design ◽

Health And Well Being

Abstract Background: Non-communicable diseases (NCDs) are a leading cause of health loss worldwide, in part due to unhealthy lifestyles. Metabolic-based diseases are rising with an unhealthy body-mass index (BMI) in rural areas as the main risk factor in adults. Health loss risks in rural areas may be amplified by wider determinants such as socio-demography and surrounding environments. We assessed weather (un)healthy lifestyles and environment in rural neighbourhoods are reflected into metabolic risks and health capability, and how community circumstances may impact the self-ability for making balanced decisions.Methods: We conducted a community-based cross-sectional study in fifteen Portuguese rural neighbourhoods (with high ageing index and high illiteracy) to describe individuals’ health functioning condition and to characterize the community environment. We followed a qualitatively driven mixed-method design, using a healthy lifestyle assessment toolkit, to gather evidence-based data and lifestyles (incorporated in eVida technology), within a random sample of 270 individuals; and 107 in-depth interviews to determine whether environment influence the capability for improving or pursuing heath and well-being.Results: Men showed to have a 75% higher probability of being overweight than women (p-value=0.0954); and the reporting of health loss risks was higher in women (RR: 1.48; p-value=0.122), individuals with larger waist circumference (RR: 2.21; IC: 1.19; 4.27), overweight and obesity (RR: 1.38; p-value=0.293) and participants aged over 75 years (RR: 1.78; p-value= 0.235; when compared with participants under 40 years old). Metabolic risks were more associated to BMI and physical activity than diet (or sleeping habits); participants strongly evidenced the adherence to a Mediterranean dietary pattern. From the interviews, we identified seven environmental circumstances reflecting health needs, health expectations and health capability: economic development, built environment, social network, health care, demography, active lifestyles, and mobility. And, while the starting point of the interview addressed community needs, participants expressed the value of natural environment in their neighbourhood as the main positive effect to pursuing health and well-being, with particular emphasis to lower exposure to air / noise pollution, daily routines linked to nature or land use, and diversity of nature experiences.Conclusions: Our qualitatively driven mixed-method design, involving the community, uncovers environment contextual-dependent circumstances influencing the ability of individuals to pursue healthy habits. The active participation of local representatives, with its degrees of negotiation and flexibility, contributed to adapt the health-related messages. The co-benefits from this co-designing community program advance the evidence to support academy-community driven interventions for pushing health and well-being at a broader social, health care and (natural) environment agenda in rural neighbourhoods.

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Impact of using eHealth tools to extend health services to rural areas of Nigeria: protocol for a mixed-method, non-randomised cluster trial

BMJ Open ◽

10.1136/bmjopen-2018-022174 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022174 ◽

Cited By ~ 3

Author(s):

Bassey Ebenso ◽

Matthew John Allsop ◽

Babasola Okusanya ◽

Godwin Akaba ◽

Jamilu Tukur ◽

...

Keyword(s):

Health Services ◽

Health Systems ◽

Mixed Method ◽

Rural Areas ◽

Satellite Communications ◽

Sub Saharan Africa ◽

Client Outcomes ◽

Cluster Trial ◽

The Impact ◽

Support Cost

IntroductioneHealth solutions that use internet and related technologies to deliver and enhance health services and information are emerging as novel approaches to support healthcare delivery in sub-Saharan Africa. Using digital technology in this way can support cost-effectiveness of care delivery and extend the reach of services to remote locations. Despite the burgeoning literature on eHealth approaches, little is known about the effectiveness of eHealth tools for improving the quality and efficiency of health systems functions or client outcomes in resource-limited countries. eHealth tools including satellite communications are currently being implemented at scale, to extend health services to rural areas of Nigeria, in Ondo and Kano States and the Federal Capital Territory. This paper shares the protocol for a 2-year project (‘EXTEND’) that aims to evaluate the impact of eHealth tools on health system functions and health outcomes.Methodology and analysisThis multisite, mixed-method evaluation includes a non-randomised, cluster trial design. The study comprises three phases—baseline, midline and endline evaluations—that involve: (1) process evaluation of video training and digitisation of health data interventions; (2) evaluation of contextual influences on the implementation of interventions; and (3) impact evaluation of results of the project. A convergent mixed-method model will be adopted to allow integration of quantitative and qualitative findings to achieve study objectives. Multiple quantitative and qualitative datasets will be repeatedly analysed and triangulated to facilitate better understanding of impact of eHealth tools on health worker knowledge, quality and efficiency of health systems and client outcomes.Ethics and disseminationEthics approvals were obtained from the University of Leeds and three States’ Ministries of Health in Nigeria. All data collected for this study will be anonymised and reports will not contain information that could identify respondents. Study findings will be presented to Ministries of Health at scientific conferences and published in peer-reviewed journals.Trial registration numberISRCTN32105372; Pre-results.

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Quantifying Pregnant Women’s Knowledge of Educational Components of Antenatal Care in Lesotho

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/4317 ◽

2019 ◽

Vol 21 (1) ◽

Author(s):

Tabeta Seeiso ◽

Mamutle M. Todd-Maja

Keyword(s):

Antenatal Care ◽

Maternal Mortality ◽

Pregnant Women ◽

Rural Areas ◽

Geographic Location ◽

Sub Saharan Africa ◽

World Health ◽

Cross Sectional ◽

Danger Signs ◽

In Pregnancy

Antenatal care (ANC) literacy is particularly important for pregnant women who need to make appropriate decisions for care during their pregnancy and childbirth. The link between inadequate health literacy on the educational components of ANC and maternal mortality in sub-Saharan Africa (SSA) is undisputable. Yet, little is known about the ANC literacy of pregnant women in SSA, with most studies inadequately assessing the four critical components of ANC literacy recommended by the World Health Organization, namely danger signs in pregnancy; true signs of labour; nutrition; and preparedness for childbirth. Lesotho, a country with one of the highest maternal mortality rates in SSA, is also underexplored in this research area. This cross-sectional study explored the levels of ANC literacy and the associated factors in 451 purposively sampled women in two districts in Lesotho using a structured questionnaire, making recourse to statistical principles. Overall, 16.4 per cent of the participants had grossly inadequate ANC literacy, while 79.8 per cent had marginal levels of such knowledge. The geographic location and level of education were the most significant predictors of ANC literacy, with the latter variable further subjected to post hoc margins test with the Bonferroni correction. The participants had the lowest scores on knowledge of danger signs in pregnancy and true signs of labour. Adequate ANC literacy is critical to reducing maternal mortality in Lesotho. Improving access to ANC education, particularly in rural areas, is recommended. This study also provides important recommendations critical to informing the national midwifery curriculum.

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The impact of the COVID-19 pandemic on socio-economic and sustainability

Environmental Science and Pollution Research ◽

10.1007/s11356-021-14986-0 ◽

2021 ◽

Author(s):

Xueli Wei ◽

Lijing Li ◽

Fan Zhang

Keyword(s):

World Economy ◽

Social Economy ◽

Secondary Data ◽

Well Being ◽

Cross Sectional ◽

The Social ◽

The World ◽

The Status ◽

Sectional Analysis ◽

The Impact

Pumping elephantThe COVID-19 pandemic has adversely affected the lives of people around the world in millions of ways . Due to this severe epidemic, all countries in the world have been affected by all aspects, mainly economic. It is widely discussed that the COVID-19 outbreak has affected the world economy. When considering this dimension, this study aims to examine the impact of the COVID-19 pandemic on the world economy, socio-economics, and sustainability. In addition, the research focuses on multiple aspects of social well-being during the pandemic, such as employment, poverty, the status of women, food security, and global trade. To this end, the study used time series and cross-sectional analysis of the data. The second-hand data used in this study comes from the websites of major international organizations. From the analysis of secondary data, the conclusion of this article is that the impact of the pandemic is huge. The main finding of the thesis is that the social economy is affected by the pandemic, causing huge losses in terms of economic well-being and social capital.

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The impact of COVID‐19 on work, training and well‐being experiences of nursing associates in England: A cross‐sectional survey

Nursing Open ◽

10.1002/nop2.928 ◽

2021 ◽

Author(s):

Rachel King ◽

Tony Ryan ◽

Michaela Senek ◽

Emily Wood ◽

Bethany Taylor ◽

...

Keyword(s):

Well Being ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Work Training ◽

The Impact

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COVID-19 restrictions and changing sexual behaviours in HIV-negative MSM at high risk of HIV infection in London, UK

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054768 ◽

2021 ◽

pp. sextrans-2020-054768

Author(s):

Iain Hyndman ◽

Diarmuid Nugent ◽

Gary George Whitlock ◽

Alan McOwan ◽

Nicolò Girometti

Keyword(s):

High Risk ◽

Hiv Infection ◽

Sexual Activity ◽

Sexual Behaviour ◽

Well Being ◽

Categorical Variables ◽

Cross Sectional ◽

The Impact ◽

Mental Well Being ◽

Hiv Negative

ObjectivesThe COVID-19 pandemic and its related restrictions have affected attendance to and delivery of UK sexual healthcare services (SHS). We surveyed the impact on sexual behaviour of men having sex with men (MSM) to inform future SHS provision.MethodsWe conducted a cross-sectional, anonymous, web-based survey among HIV-negative MSM at high risk of HIV infection who attended 56 Dean Street, a sexual health and HIV clinic. The survey was conducted over a 7-day period in August 2020. Data on sociodemographic characteristics, sexual behaviour and related mental well-being experienced during lockdown (defined as 23 March–30 June 2020) were extracted. Categorical and non-categorical variables were compared according to HIV pre-exposure prophylaxis (PrEP) use.Results814 MSM completed the questionnaire: 75% were PrEP users; 76% reported they have been sexually active, of which 76% reported sex outside their household. 75% reported fewer partners than prior to lockdown. Isolation/loneliness (48%) and anxiety/stress (27%) triggered sexual activity, and 73% had discussed COVID-19 transmission risks with their sexual partners. While 46% reported no change to emotions ordinarily experienced following sex, 20% reported guilt for breaching COVID-19 restrictions. 76% implemented one or more changes to their sexual behaviour, while 58% applied one or more steps to reduce COVID-19 transmission during sex. 36% accessed SHS and 30% reported difficulties in accessing testing/treatment. Of those who accessed SHS, 28% reported an STI diagnosis. PrEP users reported higher partner number, engagement in ‘chemsex’ and use of SHS than non-PrEP users.ConclusionsCOVID-19 restrictions had a considerable impact on sexual behaviour and mental well-being in our survey respondents. High rates of sexual activity and STI diagnoses were reported during lockdown. Changes to SHS provision for MSM must respond to high rates of psychological and STI-related morbidity and the challenges faced by this population in accessing services.

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Characteristics of those most vulnerable to employment changes during the COVID-19 pandemic: a nationally representative cross-sectional study in Wales

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-216030 ◽

2021 ◽

pp. jech-2020-216030

Author(s):

Benjamin J Gray ◽

Richard G Kyle ◽

Jiao Song ◽

Alisha R Davies

Keyword(s):

Multinomial Logistic Regression ◽

Household Survey ◽

Well Being ◽

Employment Outcomes ◽

Cross Sectional Study ◽

Public Health Response ◽

Cross Sectional ◽

Exact Test ◽

Nationally Representative ◽

The Impact

BackgroundThe public health response to the SARS-CoV-2 (COVID-19) pandemic has had a detrimental impact on employment and there are concerns the impact may be greatest among the most vulnerable. We examined the characteristics of those who experienced changes in employment status during the early months of the pandemic.MethodsData were collected from a cross-sectional, nationally representative household survey of the working age population (18–64 years) in Wales in May/June 2020 (n=1379). We looked at changes in employment and being placed on furlough since February 2020 across demographics, contract type, job skill level, health status and household factors. χ2 or Fisher’s exact test and multinomial logistic regression models examined associations between demographics, subgroups and employment outcomes.ResultsOf our respondents, 91.0% remained in the same job in May/June 2020 as they were in February 2020, 5.7% were now in a new job and 3.3% experienced unemployment. In addition, 24% of our respondents reported being placed on furlough. Non-permanent contract types, individuals who reported low mental well-being and household financial difficulties were all significant factors in experiencing unemployment. Being placed on ‘furlough’ was more likely in younger (18–29 years) and older (60–64 years) workers, those in lower skilled jobs and from households with less financial security.ConclusionA number of vulnerable population groups were observed to experience detrimental employment outcomes during the initial stage of the COVID-19 pandemic. Targeted support is needed to mitigate against both the direct impacts on employment, and indirect impacts on financial insecurity and health.

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Public Sector Employment, Quality of Government, and Well-Being: A Global Analysis

International Area Studies Review ◽

10.1177/22338659211011747 ◽

2021 ◽

pp. 223386592110117

Author(s):

Robert Davidson ◽

Alexander Pacek ◽

Benjamin Radcliff

Keyword(s):

Public Sector ◽

Global Analysis ◽

Well Being ◽

Subjective Well Being ◽

Cross Sectional ◽

Political Factors ◽

The Public ◽

Employment Quality ◽

The Impact

While a growing literature within the study of subjective well-being demonstrates the impact of socio-political factors on subjective well-being, scholars have conspicuously failed to consider the role of the size and scope of government as determinants of well-being. Where such studies exist, the focus is largely on the advanced industrial democracies of the Organization for Economic Co-Operation and Development. In this study, we examine the size of the public sector as a determinant of cross-national variation in life satisfaction across a worldwide sample. Our findings strongly suggest that as the public sector grows, subjective well-being increases as well, conditional on the extent of quality of government. Using cross-sectional data on 84 countries, we show this relationship has an independent and separable impact from other economic and political factors.

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Contributing Factors in Adolescents’ Mental Well-Being—The Role of Socioeconomic Status, Social Support, and Health Behavior

Sustainability ◽

10.3390/su12229597 ◽

2020 ◽

Vol 12 (22) ◽

pp. 9597

Author(s):

Gabriella Nagy-Pénzes ◽

Ferenc Vincze ◽

Éva Bíró

Keyword(s):

Social Support ◽

Socioeconomic Status ◽

Life Satisfaction ◽

Health Behavior ◽

Mental Health Problems ◽

Well Being ◽

Cross Sectional ◽

Unhealthy Eating ◽

The Impact ◽

Mental Well Being

Mental disorders are common in adolescents, and for effective interventions we should be aware of their determinants. However, there are only a small number of studies investigating the combined effect of multiple factors. Therefore, our aim is to assess the impact of socioeconomic status, social support, and health behavior on adolescents’ mental well-being. A cross-sectional health survey of 1641 children was carried out in accordance with the study protocol of the Hungarian Health Behavior in School-aged Children survey. Multivariate multiple regression was used to analyze the main determinants of mental well-being. The boys’ mental well-being was favorable compared to girls; lower subjective family wealth was associated with lower life satisfaction and depressive mood. Life satisfaction was positively related to healthy eating, social support, and physical activity. Unhealthy eating, sedentary lifestyle, and lower social support were associated with higher depression scores. Higher social support reduces psychosomatic symptoms, while unhealthy eating and spending a lot of time in front of the computer increase them. Both social support and healthy lifestyle seem to be protective against mental health problems among adolescents, and thus interventions should focus on these factors regardless of the socioeconomic status of the participants, with special attention given to girls.

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Beyond vision loss: the independent impact of diabetic retinopathy on vision-related quality of life in a Chinese Singaporean population

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313082 ◽

2018 ◽

Vol 103 (9) ◽

pp. 1314-1319 ◽

Cited By ~ 1

Author(s):

Eva K Fenwick ◽

Ryan E K Man ◽

Alfred Tau Liang Gan ◽

Neelam Kumari ◽

Charlene Wong ◽

...

Keyword(s):

Quality Of Life ◽

Diabetic Retinopathy ◽

Vision Loss ◽

Well Being ◽

Linear Regression Models ◽

Cross Sectional ◽

Significant Difference ◽

Related Quality ◽

The Impact

Background/aimsTo assess the independent impact of diabetic retinopathy (DR) on three domains of vision-related quality of life (VRQoL) in a Chinese Singapore population.MethodsThe Singapore Chinese Eye Study (n=3353; 2009–2011) was a population-based, prospective, cross-sectional study conducted at the Singapore Eye Research Institute. The study population included 292 adults with diabetes, with and without DR. DR (better eye) was categorised as presence and absence of any DR; severity of DR (no vision-threatening DR (VTDR); severe non-proliferative DR (NPDR); PDR and/or clinically significant macular oedema and VTDR). Our main outcome was VRQoL which was measured using Rasch-calibrated scores from the ‘Reading’, ‘Mobility’ and ‘Emotional’ domains of the Impact of Vision Impairment questionnaire. The relationship between DR and VRQoL was assessed using multiple linear regression models.ResultsOf the 292 individuals (mean age 61.35 ± 9.66 years; 55.8% male), 201 (68.8%), 49 (16.8%), 20 (6.8%), 22 (7.5%) and 27 (9.2%) had no DR, minimal-mild NPDR, moderate-severe NPDR, PDR and VTDR, respectively. Any DR and VTDR were independently associated with 6% and 12% worse Reading scores and 7% and 18% poorer Emotional well-being, respectively, compared with those without DR. These associations persisted after separate adjustment for visual impairment and presenting visual acuity. No significant difference was found in the Mobility domain between persons with and without DR.ConclusionsWe documented that DR, particularly VTDR, was independently associated with restrictions in Reading and Emotional well-being. Understanding factors underlying the detrimental DR-VRQoL relationship may optimise rehabilitation outcomes for individuals with DR.

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